Giant cell arteritis (GCA) affects approximately 1 in 50adults over the age of 50. Seventy-two is the averageage of diagnosis. The disease rarely occurs in youngerpatients.1 GCA is an arteritis or vasculitis; the classicfeature is inflamed blood vessels. The vessels mostfrequently affected are the arteries of the head andscalp. Most commonly affected are the temporal arter-ies, so temporal arteritis is another term for GCA.2

GCA is a frequent indication for chronic gluco-corticosteroid treatment and one of the mostcommon causes of blindness. As many as onefifth of patients may lose their vision to GCA.Late recognition may play a role in vision loss.Immediate recognition and treatment are vital inthis disease.3 If GCA is suspected, a biopsy ofthe temporal artery is necessary. Imaging studies,including positron emission tomography, mag-netic resonance angiography, Doppler ultrasound,and conventional angiography, can also helpestablish the diagnosis.1

The American College of Rheumatology released itscriteria for the classification of GCA in 1990. Three ofthe 5 criteria need to be met (Table 1), including onsetof a new headache, age of onset, abnormal biopsy,increased erythrocyte sedimentation rate, and abnor-mal physical exam of temporal artery.4 Common signsand symptoms of GCA can be found in Box 1. Theyinclude visual changes, head and scalp pain, constitu-tional symptoms, polymyalgic symptoms, and jawclaudication.3 The symptoms can vary from 1 patientto another. Manifestations can also be transient andintermittent. Therefore, patients with suspected GCAshould be carefully questioned.1

While not a common diagnosis, GCA is one thata nurse practitioner would not want to miss.

References

1. Hunder G. Diagnosis of giant cell (temporal) arteritis. http://www.uptodate.com/contents/diagnosis-of-giant-cell-temporal-arteritis?source=search_result&search=diagnosis+of+giant+cell+temporal+arteritis&selectedTitle=1%7E150. Updated January 13, 2011. AccessedDecember 26, 2011.

2. Docken W; American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/giantcellarteritis.asp. Updated June 2009. Accessed December 30,2011.

3. Dasgupta B. Concise guidance: diagnosis and management of giantcell arteritis. Clin Med. 2010;10(4):381-386.

4. Hunder GG, Bloch DA, Michel BA, et al. The American College ofRheumatology 1990 criteria for the classification of giant cellarteritis. Arthritis Rheum. 1990;33:1122-8. Cited by: The AmericanCollege of Rheumatology Web site. http://www.rheumatology.org/practice/clinical/classification/tca.asp. Accessed December 26, 2011.

1555-4155/121/$ see front matter© 2012 American College of Nurse Practitionersdoi: 10.1016/j.nurpra.2012.01.024

JNP

DIAGNOSTIC TIPS

Cynthia Watkins, FNP

412 The Journal for Nurse Practitioners - JNP Volume 8, Issue 5, May 2012

Could It Be Giant Cell Arteritis?

Cynthia Watkins, RN, MSN, FNP, works at Parkland Hospitalin Dallas, Texas, where she does homeless medical outreach.She can be reached at cynthia.watkins@phhs.org.

Box 1. Common Signs and Symptoms of GCA

Abrupt onset of unilateral and temporal headache

Localized or diffuse scalp painTongue and jaw claudicationBlurred vision, diplopiaConstitutional symptoms: fatigue, weight loss,

fever, polymyalgiasLimb claudication

Table 1. 1990 Criteria for the Classification of GiantCell Arteritis

1. Age of disease onset � 50: development ofsymptoms or findings beginning at age 50or older

2. New headache: new onset of new type orlocalized pain in the head

3. Temporal artery abnormality: temporalartery tenderness to palpation or decreasedpulsation unrelated to arteriosclerosis ofcervical arteries

4. Elevated erythrocyte sedimentation rate:erythrocyte sedimentation rate � 50 mm/hrby the Westergren method

5. Abnormal artery biopsy: biopsy specimenwith artery showing vasculits characterizedby a predominance of mononuclear cellinfiltration or granulomatous inflammation,usually with multinucleated giant cells