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Giant Cell Arteritis Diagnosis and Management Update

What is Giant Cell Arteritis?. Ophthalmic Emergency. . ??.GCA ranks as the prime medical emergency in ophthalmology, there being no other disease in which prevention of blindness depends so much on prompt recognition and early treatment?'Kearns 1975. Sight Threatening and Treatable. What is Giant Cell Arteritis?.

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Giant Cell Arteritis Diagnosis and Management Update

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    1. Giant Cell Arteritis Diagnosis and Management Update Roger Baer May 2008

    2. What is Giant Cell Arteritis? Ophthalmic Emergency

    3. What is Giant Cell Arteritis?

    5. Diagnostic Criteria Age (=50y.o) New onset of localised headache Temporal artery tenderness or decreased temporal artery pulsation Elevated ESR (=50mm/h) Positive TAB

    7. Hayreh & Zimmerman Study Opthalmologica August 2003; 217:239-259 Sohan Singh Hayreh, Bridget Zimmerman

    8. Hayreh & Zimmerman Study Occult GCA 21.2% of patients with visual loss and a positive TAB had no other symptoms

    9. Hayreh & Zimmerman Study Criteria Missing from ACR Guidelines Likelihood of a positive TAB were: ? 9.0 times greater if associated with jaw claudication ? 3.4 times greater if associated with neck pain ? 3.2 times greater if associated with CRP >24.5mg/l

    10. Hayreh & Zimmerman Study Headache & Scalp Tenderness 55.7% of patients with a positive TAB complained of a ‘new onset of localised headache’

    12. Hayreh & Zimmerman Study Clinically Abnormal Temporal Artery 19.8% of patients with a positive TAB had temporal artery tenderness or decreased temporal artery pulsation

    13. Hayreh & Zimmerman Study Elevated ESR Whilst the ACR guidelines advocated an ESR of =50mm/h, this study showed a presenting ESR in patients with a positive biopsy of 4-140mm/h.

    14. Hayreh & Zimmerman Study Conclusion Reliance on the ACR Guidelines is likely to result in both false-negative and false-positive diagnoses of Giant Cell Arthritis

    15. Hayreh & Zimmerman Study

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    25. Hayreh & Zimmerman Study Age (=55y.o) Yes, check inflammatory markers Visual symptoms? No, consider other criteria: Jaw claudication CRP >24.5mg/l Neck pain ESR >47mm/h Age =75y.o Temporal Artery Biospy

    26. Hayreh & Zimmerman Study

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