Giant cell arteritis

Giant cell arteritis (GCA) is an inflammatory disease that affects medium and large blood vessels, classically the extracranial branches of the external carotid arteries. Inflammation in the wall of the affected artery may cause headache, scalp tenderness, jaw and tongue pain, and visual disturbances, but can also present with systemic or other less common symptoms, so that diagnosis can be challenging. It is a rare disease affecting 2.2 per 10 000 patient-years in the UK.1 Consequences can be serious if the diagnosis is delayed, and may include visual loss, stroke, and aortic aneurysm. Many patients with GCA first present to their general practitioner or local emergency department. The most common presenting symptom of GCA is headache (76%)1 but given its relative rarity, other causes of headache are much more common in these settings. Glucocorticosteroids are the mainstay of treatment, but at high doses and for prolonged periods of time are associated with substantial side effects. In April 2019, the National Institute for Health and Care Excellence (NICE) licensed tocilizumab for patients with refractory or relapsing disease.2 This article provides a practical update for non-specialists with particular emphasis on making a diagnosis and initial management. It also discusses the new NICE …