Intended for healthcare professionals

Practice Easily Missed?

Giant cell arteritis

BMJ 2011; 342 doi: (Published 23 May 2011) Cite this as: BMJ 2011;342:d3019
  1. Nada Hassan, specialist registrar1,
  2. Bhaskar Dasgupta, consultant rheumatologist1,
  3. Kevin Barraclough, general practitioner2
  1. 1Rheumatology, Southend University Hospital, Westcliff-on-Sea SS0 0RY, UK
  2. 2Greenbank, Painswick GL6 6TY, UK
  1. Correspondence to: K Barraclough k.barraclough{at}
  • Accepted 28 January 2011

Case scenario

A previously fit and well 72 year old man presented to his general practitioner after several months of malaise and weight loss. When asked about any pain, he pointed to his left scalp as being painful. Examination was normal except that his left temporal artery was not palpable. Suspecting giant cell arteritis, the GP started 40 mg prednisolone and requested an erythrocyte sedimentation rate, which was 86 mm/h. The symptoms largely disappeared in 48 hours. She also referred the patient for a temporal artery biopsy, which showed giant cell arteritis.

Giant cell arteritis affects large and medium sized arteries, often branches of the external carotid artery but also the ciliary and retinal arteries. The symptoms are caused by local ischaemia due to endovascular damage and cytokine mediated systemic illness. There is considerable overlap with polymyalgia rheumatica: 16-21% of patients with polymyalgia rheumatica have giant cell arteritis on temporal artery biopsy, and symptoms of polymyalgia rheumatica are present in 40-60% of patients with giant cell arteritis.1

How common is it?

  • Giant cell arteritis occurs in 2.2 per 10 000 patient years in the United Kingdom2

  • A full time general practitioner may expect to see one new case every 1-2 years

  • It is virtually unknown in people aged under 50

Why is giant cell arteritis missed?

A systematic review analysed the presenting clinical features in a mixture of studies with a total of 1435 cases of giant cell arteritis.3 The sensitivity of individual clinical features was relatively …

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