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Giant Cell Arteritis (Gca) (Temporal Arteritis)

Giant Cell Arteritis (Gca) (Temporal Arteritis) is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Chronic vasculitis of large- and medium-sized vessels that occurs among individuals over 50 yr of age
  • Often referred to as temporal arteritis (TA)
  • Median age of onset is 72
  • Most commonly causes inflammation of arteries originating from the arch of the aorta
  • Although usually clinically silent, involvement of the thoracic aorta occurs in a significant minority of patients, and aortic aneurysm or dissection may result
  • Thoracic aortic aneurysm is a late manifestation with an incidence 17 times those without TA
  • Abdominal aortic aneurysm is about twice as common in those with giant cell arteritis (GCA)
  • Pathologic specimens feature patchy mononuclear granulomatous inflammation resulting in a markedly thickened intima and occlusion of the vessel lumen
  • Occlusive arteritis may involve thrombosis of the ophthalmic artery resulting in anterior ischemic optic neuropathy (AION) and acute visual loss:
    • Visual symptoms are an ophthalmic emergency
  • Inflammation of arteries supplying the muscles of mastication results in jaw claudication and tongue discomfort
  • Age is the greatest risk factor:
    • Rare in patients <50 yr old
    • >90% are >60 yr old
    • Prevalence in individuals >50 yr is estimated at 1:500
  • Increased prevalence in Northern latitude
  • 2 to 4 times more common in women
  • Rare in African American patients, common in Whites
  • There is a strong association with polymyalgia rheumatica (PMR) ∼50%

Genetics
Genetic predisposition is linked to HLA-DR4—60% prevalence

Etiology

  • Unknown
  • Genetic, enviromental and autoimmune factors have been identified

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Citation

Rosen, Peter, et al., editors. "Giant Cell Arteritis (Gca) (Temporal Arteritis)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307633/all/Giant_Cell_Arteritis__Gca___Temporal_Arteritis_.
Giant Cell Arteritis (Gca) (Temporal Arteritis). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307633/all/Giant_Cell_Arteritis__Gca___Temporal_Arteritis_. Accessed April 25, 2019.
Giant Cell Arteritis (Gca) (Temporal Arteritis). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307633/all/Giant_Cell_Arteritis__Gca___Temporal_Arteritis_
Giant Cell Arteritis (Gca) (Temporal Arteritis) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307633/all/Giant_Cell_Arteritis__Gca___Temporal_Arteritis_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Giant Cell Arteritis (Gca) (Temporal Arteritis) ID - 307633 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307633/all/Giant_Cell_Arteritis__Gca___Temporal_Arteritis_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -