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Flashcards in GCA Deck (11)
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1
Q

What is the pathophysiology of GCA?

A

The pathological mechanism seems to start when dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates.

Giant-cell indicates the union of several distinct cells to form a granuloma, therefore this is a granulomatous large vessel vasculitis.

2
Q

What type of individual does GCA occur in?

A
  • Elderly
  • Those with PMR
3
Q

How does GCA present?

A
  • Fever
  • Temporal/Generalised headache
  • Scalp tenderness
  • Jaw Claudication - can also get tongue claudication
  • Sudden painless blindness - amaurosis fugax (occlusion of the opthalmic artery)
  • Dyspnoea
  • Morning stiffness
  • Unequal/weak pulses
4
Q

How would you investigate suspected GCA?

A

Bloods

  • ESR + CRP - increased
  • Platelets - increased
  • Alk Phos - increased
  • Hb - decreased - normocytic normochromic
  • Albumin - low

Diagnosis

  • Temporal Artery Biopsy - within 7 days of starting steroids
5
Q

How would you treat someone with suspected GCA?

A
  • High Dose Steroids - Prednisolone 60-100mg/day - immediately
  • Calcium and Vitamin D
  • PPI
6
Q

What is are potential complications of GCA?

A
  1. Sudden painless irreversible mono/bilateral blindness
  2. Aortic dissection
  3. Aortic Aneurysm
7
Q

What diagnosis would you consider if someone presented with symptoms of GCA but they were <55yrs?

A

Takayasu’s arteritis

8
Q

What are histological features of GCA?

A
  • Intimal hypertrophy
  • Inflammation of the intima
  • Degredation of the internal elastic lamina
  • Giant cells, lymphocytes and plasma cells in the internal elastic lamina
9
Q

How long does it normally take to resolve GCA?

A

12-36 months

10
Q

What dose of steroids would you start someone on with GCA?

A

60-100 mg/day oral

11
Q

If symptoms of GCA resolved on treatment, what would you consider doing?

A

Decreasing, but NOT stopping steroids