Diagnosis of giant cell (temporal) arteritis
- Gene G Hunder, MD
Gene G Hunder, MD
- Section Editor — Vasculitis
- Emeritus Consultant
- Professor Emeritus
- Mayo Clinic College of Medicine
- Section Editors
- Jonathan Trobe, MD
Jonathan Trobe, MD
- Section Editor — Ophthalmology
- Professor of Ophthalmology and Visual Sciences
- Professor of Neurology
- University of Michigan Kellogg Eye Center
- Eric L Matteson, MD, MPH
Eric L Matteson, MD, MPH
- Section Editor — Treatment Issues in Rheumatology
- Chair, Division of Rheumatology
- Professor of Medicine
- Mayo Clinic College of Medicine
Giant cell arteritis (GCA) is a chronic vasculitis of large- and medium-sized vessels. The mean age at diagnosis is approximately 72 years, and the disease essentially never occurs in individuals younger than 50 . Among individuals older than 50, the prevalence of GCA has been estimated to be 1 in 500 individuals .
Although GCA is characteristically a systemic illness and although vascular involvement may be widespread, symptomatic blood vessel inflammation most frequently involves the cranial branches of the arteries that originate from the aortic arch. The most feared complication of GCA, visual loss, is one potential result of the cranial arteritis associated with this disease.
The diagnosis of GCA will be reviewed here. The pathogenesis, clinical manifestations, and treatment of this disorder are discussed separately. (See "Pathogenesis of giant cell (temporal) arteritis" and "Clinical manifestations of giant cell (temporal) arteritis" and "Treatment of giant cell (temporal) arteritis".)
The diagnosis of giant cell arteritis (GCA) should be considered in a patient over the age of 50 who complains of or is found to have:
- Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA 2002; 287:92.
- Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41:778.
- Myklebust G, Gran JT. A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis. Br J Rheumatol 1996; 35:1161.
- Hall S, Persellin S, Lie JT, et al. The therapeutic impact of temporal artery biopsy. Lancet 1983; 2:1217.
- Younge BR, Cook BE Jr, Bartley GB, et al. Initiation of glucocorticoid therapy: before or after temporal artery biopsy? Mayo Clin Proc 2004; 79:483.
- Brack A, Martinez-Taboada V, Stanson A, et al. Disease pattern in cranial and large-vessel giant cell arteritis. Arthritis Rheum 1999; 42:311.
- Achkar AA, Lie JT, Hunder GG, et al. How does previous corticosteroid treatment affect the biopsy findings in giant cell (temporal) arteritis? Ann Intern Med 1994; 120:987.
- Evans JM, Batts KP, Hunder GG. Persistent giant cell arteritis despite corticosteroid treatment. Mayo Clin Proc 1994; 69:1060.
- Gabriel SE, O'Fallon WM, Achkar AA, et al. The use of clinical characteristics to predict the results of temporal artery biopsy among patients with suspected giant cell arteritis. J Rheumatol 1995; 22:93.
- Bley TA, Wieben O, Uhl M, et al. High-resolution MRI in giant cell arteritis: imaging of the wall of the superficial temporal artery. AJR Am J Roentgenol 2005; 184:283.
- Tso E, Flamm SD, White RD, et al. Takayasu arteritis: utility and limitations of magnetic resonance imaging in diagnosis and treatment. Arthritis Rheum 2002; 46:1634.
- Evans JM, Bowles CA, Bjornsson J, et al. Thoracic aortic aneurysm and rupture in giant cell arteritis. A descriptive study of 41 cases. Arthritis Rheum 1994; 37:1539.
- Klein RG, Hunder GG, Stanson AW, Sheps SG. Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med 1975; 83:806.
- Puéchal X, Chauveau M, Menkès CJ. Temporal Doppler-flow studies for suspected giant-cell arteritis. Lancet 1995; 345:1437.
- Ho AC, Sergott RC, Regillo CD, et al. Color Doppler hemodynamics of giant cell arteritis. Arch Ophthalmol 1994; 112:938.
- Schmidt WA, Kraft HE, Vorpahl K, et al. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med 1997; 337:1336.
- Pfadenhauer K, Weber H. Duplex sonography of the temporal and occipital artery in the diagnosis of temporal arteritis. A prospective study. J Rheumatol 2003; 30:2177.
- Salvarani C, Silingardi M, Ghirarduzzi A, et al. Is duplex ultrasonography useful for the diagnosis of giant-cell arteritis?. Ann Intern Med 2002; 137:232.
- Karassa FB, Matsagas MI, Schmidt WA, Ioannidis JP. Meta-analysis: test performance of ultrasonography for giant-cell arteritis. Ann Intern Med 2005; 142:359.
- Maldini C, Dépinay-Dhellemmes C, Tra TT, et al. Limited value of temporal artery ultrasonography examinations for diagnosis of giant cell arteritis: analysis of 77 subjects. J Rheumatol 2010; 37:2326.
- Muratore F, Boiardi L, Restuccia G, et al. Comparison between colour duplex sonography findings and different histological patterns of temporal artery. Rheumatology (Oxford) 2013; 52:2268.
- Hunder GG, Weyand CM. Sonography in giant-cell arteritis. N Engl J Med 1997; 337:1385.
- Blockmans D, Stroobants S, Maes A, Mortelmans L. Positron emission tomography in giant cell arteritis and polymyalgia rheumatica: evidence for inflammation of the aortic arch. Am J Med 2000; 108:246.
- Scheel AK, Meller J, Vosshenrich R, et al. Diagnosis and follow up of aortitis in the elderly. Ann Rheum Dis 2004; 63:1507.
- Blockmans D. Utility of imaging studies in assessment of vascular inflammation. Cleve Clin J Med 2002; 69 Suppl 2:SII95.
- Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum 1990; 33:1122.
- Kerr GS. Takayasu's arteritis. Rheum Dis Clin North Am 1995; 21:1041.
- Lie JT. When is arteritis of the temporal arteries not temporal arteritis? J Rheumatol 1994; 21:186.
- Salvarani C, Brown RD Jr, Calamia KT, et al. Primary central nervous system vasculitis: analysis of 101 patients. Ann Neurol 2007; 62:442.
- Lakhanpal S, Li CY, Gertz MA, et al. Synovial fluid analysis for diagnosis of amyloid arthropathy. Arthritis Rheum 1987; 30:419.
- Lessell S. Nonarteritic anterior ischemic optic neuropathy: enigma variations. Arch Ophthalmol 1999; 117:386.
- Temporal artery biopsy
- - Yield of first biopsy
- - Explanations for negative biopsies
- - Biopsy of other arteries
- - Initiating glucocorticoid therapy
- - Predicting results
- - Biopsy-negative GCA
- - Magnetic resonance imaging/angiography
- - Conventional angiography
- - Ultrasonography
- - Positron emission tomography
- CLASSIFICATION CRITERIA
- DIFFERENTIAL DIAGNOSIS
- Large-vessel vasculitides
- Small- and medium-vessel vasculitides
- Central nervous system vasculitis
- Nonvasculitic conditions
- INFORMATION FOR PATIENTS