Giant Cell Arteritis: An Update on Diagnosis and Management

Elizabeth Hazel, MD, FRCPC; Michael Starr, MD, FRCPC

Disclosures

Geriatrics and Aging. 2007;10(6):389-392. 

In This Article

Abstract and Introduction

Abstract

Giant cell arteritis (GCA) is the most common form of vasculitis in the older adult population. There are variable clinical presentations of this entity and no perfect diagnostic test, often making the diagnosis challenging. Prompt initiation of corticosteroids may prevent visual loss in affected individuals. Temporal artery biopsy remains the gold standard for diagnosing GCA. Patients require an individualized steroid tapering schedule to minimize side effects. Physicians caring for these patients should be aware of the potential for long-term vascular complications of GCA.

Introduction

In 1932, Horton, Magath, and Brown reported two cases of a "new form of arteritis affecting the temporal vessels... which probably represents a new clinical syndrome."[1] In 1934 and 1936, Horton published new cases of temporal arteritis and defined the clinical characteristics of the disease and its histology, and the disease became known as Horton's disease.[2]

Over the years, the nomenclature of this entity has been complicated. It has been alternatively called cranial arteritis or temporal arteritis, reflecting the most commonly affected vessels. However, this terminology minimizes the systemic nature of this vasculitis and may be misleading. The term giant cell arteritis (GCA) reflects the pathological feature seen on biopsy of involved vessels and is more inclusive of the variable presentations of this disease (Figure 1).

Figure 1.

Giant Cell Arteritis

Giant cell arteritis is a relatively common vasculitis among older adults, with a prevalence of approximately 200 per 100,000 persons over 50 years of age.[3,4] It is more common in women with a sex ratio of about 7-8:1. The variable presentations of GCA can make the diagnosis difficult, but it is often the long-term management of these patients that presents the biggest challenge.

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