Early recognition, evaluation and treatment may prevent blindness in giant cell arteritis

Abstract

Giant cell arteritis (GCA) is a systemic vasculitis that can cause blindness in the elderly. GCA is a medical emergency since it frequently causes blindness if left untreated. Blindness can even occur in a small percentage of patients who undergo treatment. The etiology remains unknown. Presenting symptoms of GCA vary widely and visual manifestations are an extremely common mode of presentation. All physicians must have a high level of suspicion to diagnose and initiate early and aggressive treatment, which in most patients can arrest but rarely reverses the disease. Early and prolonged high-dose corticosteroids remain the cornerstone of GCA treatment. In symptomatic patients, the combination of abnormal levels of C-reactive protein in addition to Westergren erythrocyte sedimentation rate has 97% specificity in the laboratory diagnosis of GCA. The gold standard for diagnosis is the temporal artery biopsy, but biopsy-negative GCA cases have been reported.

Keywords::

• anterior ischemic optic neuropathy
• choroidal ischemia
• giant cell arteritis
• homonymous hemianopia
• pulse steroid treatment
• temporal artery biopsy
• thrombocytosis

Notes

AION: Anterior ischemic optic neuropathy; CN: Cranial nerve; CRAO: Central retinal artery occlusion; GCA: Giant cell arteritis; NFB: Nerve fiber bundle.

*A patient shall be said to have giant cell arteritis if at least three of these five criteria are present. The presence of any three or more criteria yields a sensitivity of 93% and a specificity of 91.2%. We disagree with the criteria as the only diagnostic criteria. Patients who present with highly specific isolated symptoms, such as jaw claudication and characteristic visual loss, should be considered as likely candidates for a diagnosis of giant cell arteritis, despite the fact that they do not fulfill the required number of criteria described herein.

Modified from [33].

See [33].