Giant Cell Arteritis (Temporal Arteritis )

Giant cell arteritis (GCA) is a systemic vasculitis affecting medium - to large-sized arteries, including the aorta and the extracranial branches of the carotid artery. GCA is rarely found in individuals younger than 55, and the mean age for disease presentation is 76. Patients may present with systemic symptoms such as new headache, anorexia, weight loss, neck pain, myalgia, fatigue, and anemia. There may be elevated erythrocyte sedimentation rate, temporal artery tenderness to palpation, or decreased arterial pulsation unrelated to arteriosclerosis. Patients may have scalp tenderness, visual disturbances, jaw claudication, or upper cranial palsies. GCA and polymyalgia rheumatica (PMR) have a significant clinical association: 16%-21% of cases of PMR are associated with GCA, and 40%-60% of patients diagnosed with GCA also have PMR. The most serious complication of GCA is blindness, a result of anterior ischemic optic neuropathy caused by ischemia secondary to inflammation of the ophthalmic artery supplying the optic nerve. All patients with suspected GCA should have temporal artery biopsy. Pathologic findings include a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells. Scalp necrosis is a rare but potentially life-threatening complication.