Suspected Giant Cell Arteritis

GCA is a chronic vasculitis of large vessels, predominantly affecting cranial arteries. However, it is a systemic illness and vascular involvement might be widespread. Mean age of onset is about 70; it is very rare before 50 years of age.

Scope

Referral and diagnostic protocol for suspected Giant Cell Arthritis (GCA).

Out of Scope

Any other acute Rheumatology condition.

Assessment

Typical Features of Giant Cell Arteritis (GCA)

  1. Aged over 50 yrs
  2. Raised inflammatory markers i.e. ESR greater than 50mm/hr
  3. Severe temporal headache
  4. Jaw claudication
  5. PMR type symptoms
  6. Visual disturbance
    • Blurred or double vision
    • Loss of vision (transient or persistent)
    • Visual field defects
  7. Systemic features (e.g. fever, anorexia, weight loss)

Patients with GCA will typically be over 50 with at least 2 of the above symptoms or signs

Investigations

CRP, Plasma viscosity, FBC, U&E, LFTs,

Management

Pathway for assessment, investigation and acute management of Giant Cell Arteritis - flow chart

Patient with suspected GCA

Do they have visual symptoms?

Yes

  • Start Prednisolone 60mg OD
  • Check bloods inc CRP and ESR
  • Refer urgently to opthalmology, please see referral tab for further information

No

  • Start Prednisolone 60mg OD
  • Check bloods inc FBC, CRP, Plasma viscosity and ESR
  • Refer to rheumatology, please see referral tab for further information

Referral

GP Action

1. Within working hours (Mon-Fri 9-5): Call 07775 407925 to discuss the case with the on-call rheumatologist.

  • If there is no answer please leave a message or e-mail rheumatology.sdhct@nhs.net leaving the patients details, your contact details and a brief message – We will call you back.

2. Out of hours: Leave a message on the phone AND e-mail with the patient's details and a brief message.

  • You can phone the next working day if you wish.

3. If your patient has ophthalmic symptoms refer to the on-call ophthalmologist on 07818 562917 (out of hours via switch board)

4. Arrange urgent bloods including FBC, U+Es and inflammatory markers (CRP/PV/ESR) if not already done.

  • If a patient is referred to Ophthalmology and it is not feasible/easy to do bloods at the surgery then the GP must request that the Ophthalmologists do them.

5. Regardless of visual symptoms please start your patient on:

  • Prednisolone 60mg

Supporting Information​

Pathway Group

SDHCT Consultant Rheumatologists:

Dr R Winfield , Dr C Gywnne

Publication date: November 2018

 

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