Term
| What are the key demographic risk factors for giant cell arteritis (GCA)? |
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Definition
Age >40 (peak 70–80 years).
- More common in women. |
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Term
| What symptom is pathognomonic for GCA? |
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Definition
| Jaw claudication (pain while chewing). |
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Term
| List three classic symptoms of GCA. |
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Definition
New-onset temporal headache/scalp tenderness.
2. Visual disturbances (e.g., amaurosis fugax, sudden blindness).
3. Polymyalgia rheumatica (PMR) symptoms (proximal stiffness/pain). |
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Term
| What systemic symptoms are associated with GCA? |
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Definition
| Fever, fatigue, weight loss, night sweats. |
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Term
| What is the first-line emergency management for GCA with new visual loss ? |
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Definition
Immediate IV methylprednisolone (1g for 3 days) OR oral prednisolone 60–100 mg/day if IV unavailable.
- Same-day ophthalmology referral. |
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Term
| What is the initial steroid dose for suspected GCA without visual symptoms ? |
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Definition
| Prednisolone 40–60 mg/day (do not delay for tests). |
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Term
| What blood tests are ordered for suspected GCA? |
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Definition
CRP & ESR (↑↑ in 90%).
- FBC (normocytic anemia, thrombocytosis).
- U&E, LFTs, HbA1c (baseline for steroids). |
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Term
| What is the gold standard diagnostic test for GCA? |
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Definition
| Temporal artery biopsy (perform within 1–2 weeks of starting steroids). |
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Term
| What imaging finding supports a GCA diagnosis? |
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Definition
- Ultrasound: "Halo sign" (hypoechoic wall edema).
- MRI/CT angiography for aortic involvement (e.g., aneurysm). |
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Term
| How should steroids be tapered in GCA? |
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Definition
Maintain high dose until symptoms/CRP/ESR normalize (~4 weeks).
- Reduce by 10 mg/month to 20 mg, then 1–2.5 mg/month.
- Total duration: 1–2 years. |
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Term
| What monitoring is required during steroid therapy? |
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Definition
BP, weight, glucose, bone health (calcium/vitamin D, DEXA scan).
- ESR/CRP (but relapse can occur without ↑ markers). |
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Term
| What are key complications of long-term steroids ? |
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Definition
| Weight gain, diabetes, osteoporosis, peptic ulcers, adrenal crisis if stopped abruptly. |
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Term
| What actions are taken for a major relapse (ischemic symptoms)? |
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Definition
- Urgent specialist review.
- Increase steroids to initial high dose (e.g., 60 mg prednisolone). |
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Term
| What patient advice should be given for GCA? |
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Definition
Report red flags: vision changes, jaw claudication, severe headache.
- Carry a steroid card.
- Avoid live vaccines (e.g., MMR).
- Smoking cessation, weight-bearing exercise. |
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Term
| What does the mnemonic "RED FLAGS ESR" stand for? |
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Definition
R aised CRP/ESR
- E lderly (>50)
- D iplopia/vision loss
- F ever/weight loss
- L imb/jaw claudication
- A rteritis (temporal)
- G CA emergency (steroids urgent)
- S calp tenderness
- E SR >50
- R elapse risk |
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Term
| What red flags warrant same-day referral in GCA? |
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Definition
| Visual loss, jaw/tongue claudication, severe headache. |
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Term
| What steroid-sparing agents are used for recurrent relapses? |
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Definition
| Methotrexate (15–25 mg/week) or tocilizumab (IL-6 inhibitor). |
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Term
| Why is temporal artery biopsy performed within 1–2 weeks of starting steroids? |
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Definition
| Steroids may reduce inflammation, but biopsy remains diagnostic during this window. |
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Term
| What infections should patients on steroids seek help for? |
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Definition
| Chickenpox/measles (if non-immune). |
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Term
| What percentage of GCA patients have normal ESR/CRP ? |
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Definition
| Up to 10% (do not rule out GCA if clinical suspicion is high). |
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