Reviewed on : 17 Nov 2023

Reviewed by : Hadiza Gachi Consultant Rheumatology GEH

Expires : 17 Nov 2025

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

Revised GCA Guideline November 2023

*GCA symptoms:

• Aged ≥50 years
• New onset headache (usually unilateral and temporal but can be diffuse or bilateral)
• Tender, thickened or beaded temporal artery or reduced temporal artery pulsation
• Scalp pain/tenderness or difficulty with combing hair
• Jaw or tongue claudication
• Visual symptoms (amaurosis fugax, reduced visual acuity, diplopia, blurring of vision)
• Elevated ESR and/or CRP
• Large vessel vasculitis suspected if prominent systemic symptoms, persistently elevated inflammatory markers despite steroid therapy and limb claudication

**Differential Diagnosis:

• Herpes zoster
• Migraine
• Serious intracranial pathology e.g. infiltrative base of skull/retro-orbital lesions
• Other causes of acute vision loss e.g. transient ischaemic attack
• Cluster headaches
• Cervical spondylosis
• Other upper cervical spine disease
• Sinus disease
• Temporomandibular joint pain
• Ear disease
• Other systemic vasculitides or connective tissue disease

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