GCA, the most common form of systemic vasculitis in patients over age 50, preferentially involves large- and medium-sized arteries.
Clinical Pearls
• What are the classic manifestations of GCA?
The classic manifestations are headache, jaw claudication, PMR, and visual symptoms. However, 40% of patients present with less typical manifestations, such as breast or ovarian masses, peripheral neuropathy, SIADH, or mesenteric ischemia.
• What laboratory findings are typical among patients with GCA?
In a large case series of patients with GCA, over 95% had an ESR above 50 mm/h, and over 40% had an ESR over 100mm/h. Elevation of CRP and hepatic enzymes, particularly alkaline phosphatase, a normocytic anemia, hypoalbuminemia, reactive thrombocytosis, and increased immunoglobulin levels are also commonly associated with GCA.
Morning Report Questions
Q: How is uncomplicated GCA generally managed?
A: Uncomplicated GCA can generally be controlled in the acute setting with 40 to 60 mg prednisone daily; this dose is typically tapered slowly over 9 to 12 months. For patients with visual loss, aortitis, or other widespread involvement, higher dose therapy is recommended (e.g., 1000 mg methylprednisolone intravenously each day for three days, followed by oral therapy of 1 mg/kg daily).
Q: Is the use of glucocorticoid-sparing agents recommended for patients with GCA?
A: Randomized, placebo-controlled trials have evaluated the use of methotrexate, infliximab, and etanercept as glucocorticoid sparing agents; however, the data are conflicting and further investigation is needed.
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