Giant cell arteritis

• Src: http://emedicine.medscape.com/article/809492
• Diagnostic criteria 1990 Am College of Rheumatology (3+ out of 5)
• age of onset > 50y
• new-onset headache or localized head pain
• temporal artery tenderness to palpation or reduced pulsation
• ESR > 50mmh/h
• abnml arterial biopsy (necrotizing vasculitis with granulomatous proliferation and infiltration)
• ESR: often > 80, but may be nml in 20%
• ESR: nml: age/2+5*isFemale
• CRP: usu icrd (even if nml ESR); nml: < 0.5mg/dL
• FBC: may show leukocytosis, anaemia, thrombocytosis (often > 400)
• LFT: icrd AlkPhos in 50%
• Temporal artery biopsy: within 1 week of starting corticosteroids in ED (but probably still useful within 3-4wks)
• Tx: eg 60mg Pred od: sy's usu improve within 72h; may need treatment for 1-2yrs