GCA is a is a vasculitis generally seen in the over 50’s and associated with polymyalgia rheumatic (PMR). However, unlike a lot of rheumatology, GCA is far from a benign condition that can be passed back to the GP’s, it can lead to some significant problems

• Sudden irreversible visual loss
• Development of thoracic aortic aneurysm

Diagnostic Criteria

Patients with ≥3 of the following SHOULD be treated and referred (Sens 93.5%, Spec 91.2%)

• >50 years old
• New onset headache
• Temporal artery abnormality (thickened, beaded, reduced/absent piece, tender)
• ESR >50 mm/hr
• Abnormal biopsy (this won’t happen in ED)

But remember you are looking for specific temporal artery tenderness (not a vague general tenderness)

High Risk Criteria

Visual

• NEW blurred vision (no other cause found)
• NEW binocular diplopia (i.e. only wen both eyes open)
• NEW pain in or around eye

Non-Visual

• Jaw claudication  – Not TMJ dysfunction (see below)
• Tongue claudication
• Scalp necrosis  – consider if Herpes zoster(Shingles) affecting V1 dermatome

Investigations

• Bloods: CRP, ESR, FBC, LFT, Electrolyte, Glucose, HBA1c
• CXR
• Weight

Management

High Risk Features (ANY)

Refer

• Ophthalmology (On-Call)- for urgent review (can decide on admission or out patient follow up)
• Rheumatology (in hours only – speciality team can do this next day)

Medication

• Methylprednisolone 1g IV (500mg if <50kg)

Admit

• Ophthalmology (if ANY visual features)
• Medicine (if NO visual features)

Low Risk (NO High Risk features)

Medication

• Prednisolone Oral 0.75mg/kg (min 40mg – max 60mg) OD PO
• Adcal D3 One tablet OD
• Lanzoprazole 30mg OD
• (Consider) Aspirin 75mg OD

Give 2 weeks and tell patient they need to keep taking until seen in Rheumatology clinic

Referrals

• Rheumatology – complete the proforma available on EPR and email to: cah-tr.rheumatologysecretaries@nhs.net
  • Proforma Here – Unable to find on EPR
• Ophthalmology  (On-Call)) if any eye symptoms)
• Vascular (only if requested by Rheum/Ophth)- email the Vascular Referral Form to vascularsecs.hri@cht.nhs.uk

GCA vs. TMJ dysfunction

PDF: Full guide