Giant cell arteritis

Giant cell arteritis (GCA) is a large vessel vasculitis that affects 2.2 per 10,000 people each year in the UK.

It is the commonest form of vasculitis; and only affects people over the age of 50 years.

Young patients can develop other forms of large vessel vasculitis; but DO NOT develop GCA.

It is a common cause of acute, but preventable, blindness that affects 20% of patients with GCA.

Patients with GCA may present to many departments including Rheumatology, Accident and Emergency, Ophthalmology, Emergency Medicine, Acute Medicine, Neurology, Stroke, and Care of the Elderly.

Delays in treatment must be avoided to prevent loss of vision, but prompt and accurate diagnosis is also important to avoid exposing patients who do not have GCA to potentially high doses of corticosteroids.

It is therefore essential that the relevant healthcare professionals use this guideline to accurately diagnose, investigate and treat patients with GCA.

All healthcare professionals involved in implementing this guideline should have sufficient clinical knowledge and experience to exclude other causes of presenting symptoms such as headache.

All healthcare professionals should refer patients with suspected GCA to a Rheumatologist or Ophthalmologist (as appropriate) as early as possible.

Referral

For suspected cases of Giant Cell Arteritis (GCA) please bleep one of the Rheumatology Registrars UHCW (bleep 2531 or 1365) for further advice and/or to arrange an urgent review of the patient.

Patients reporting visual symptoms should be directed urgently to Eye Casualty at UHCW.

Out of hours (9-5 Monday to Friday), patients with suspected GCA should be sent to A&E, AEC Clinic or MDU for further assessment.

There is also an on-call Consultant Rheumatologist 24 hours a day for urgent advice; this service does not cover George Eliot or Warwick Hospitals.

It would be useful if an urgent ESR could be sent off either from the GP practice or on arrival at hospital.