Giant cell arteritis

• In many cases, FUO in the elderly results from an atypical manifestation of a common disease, among which giant cell arteritis and polymyalgia rheumatica are most frequently involved.

• Females > 50 years old. 阿嫲

• Unilateral headache, possible temporal artery tenderness, jaw claudication.

• May lead to irreversible blindness due to anterior ischemic optic neuropathy.

• Associated with Polymyalgia rheumatica

• Most commonly affects branches of carotid artery.

• Focal granulomatous inflammation A . elevated of ESR. IL-6 levels correlate with disease activity.

• Treat with high-dose glucocorticoids prior to temporal artery biopsy to prevent blindness.

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• Granulomatous arteritis typically involving aorta/branches; predilection for extracranial branches of carotid a., particularly temporal a. (thus also called temporal arteritis).
• Epidemiology: 90% >60 y, peak incidence at 70–80 y, extremely rare <50 y; ♀:♂ = 3:1. Prev 2/1000 of those age ≥50 (Semin Arthritis Rheum 2017;47:253).
• Clinical manifestations of Giant cell arteritis
• diagnosis of Giant cell arteritis:
• Rx: steroids: do not await bx/path! Have >2 wks to bx w/o Δ. Pred 40–60 mg/d w/ slow taper; ASA if critical cerebral narrowing; consider IV steroids if vision threatened (Arthritis Rheumatol 2021;73:1349). Adding tocilizumab ↑ sustained remission (NEJM 2017;377:317). Polymyalgia rheumatica
• Follow clinical status & ESR/CRP; ~⅓relapse over 2 y (J Rheum 2015;42:1213)