Intended for healthcare professionals

Practice Clinical Updates

Giant cell arteritis

BMJ 2019; 365 doi: (Published 30 May 2019) Cite this as: BMJ 2019;365:l1964
  1. Karina Lazarewicz, consultant rheumatologist1,
  2. Pippa Watson, consultant rheumatologist and honorary senior lecturer2
  1. 1Rheumatology, Manchester University Foundation Trust, Trafford Hospital, Manchester, UK
  2. 2Rheumatology, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK
  1. Correspondence to K Lazarewicz karinalazarewicz{at}

What you need to know

  • Giant cell arteritis (GCA) is a medical emergency that requires immediate treatment with glucocorticosteroids

  • Headache is the most common presenting symptom but is not always present

  • Refer patients with suspected GCA and visual symptoms such as blurring, diplopia, or visual loss immediately to ophthalmology specialists, as untreated GCA with eye involvement can lead to loss of eyesight

  • Refer patients without visual symptoms urgently to rheumatology specialists

  • The mainstay of treatment is high dose prednisolone; in some patients with refractory or relapsing disease, tocilizumab can be added to prednisolone to treat GCA and act as a steroid sparing agent

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 …

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