Joint rheumatology/ophthalmology giant cell arteritis (GCA) referral guidelines

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

 

The British Society of Rheumatology’s full guideline published March 2020 is available here.

Background

Giant Cell Arteritis is a vasculitis of the Extra Cranial Arteries, especially the branches of the Carotid and Ophthalmic Arteries. Virtually unheard of in under 50’s, it is commonest in the elderly >70 years. Serious complications, such as partial or total irreversible blindness, may result if not considered, and treated urgently with high dose steroid.

When to consider GCA

Typically:

Age >50, abrupt onset usually unilateral temporal headache, with Temporal Artery abnormality eg tender, thickened, reduced or absent pulsation, and ESR > 50. (Usually, but not always, 3 or more of these will be present).

And/or may have:

Scalp tenderness, jaw and tongue claudication, visual symptoms including diplopia, “shade covering an eye”, fever, fatigue, weight loss, PMR symptoms, limb claudication.

Examine for:

Abnormal temporal artery, scalp tenderness, reduce visual acuity, pupillary defect, pale swollen haemorrhagic optic discs, central retinal artery occlusion, upper cranial nerve palsies, bruits, asymmetrical BP’s and pulses.

Consider Differential Diagnosis:

Migraine, cluster headache, herpes zoster, intra-cranial pathology, other cause visual loss eg TIA, cervical spondylosis or other C spine disease, TMJ pain, ear pathology, systemic vasculitis.

Referral process

Start treatment immediately

Uncomplicated
(ie no visual symptoms or tongue/jaw claudication)

Prednisolone 60 mg Test FBC, ESR, U&E, LFT, CRP plus urinalysis

Complicated
(ie visual symptoms or tongue/jaw claudication)

Prednisolone 60 mg daily (may get IV in DGRI) Test FBC, ESR, U&E, LFT plus urinalysis

Urgent SCI referral to Rheumatology – referrals usually checked every weekday and we will aim to see URGENTLY for a decision on whether to biopsy or not (VIA GENERAL SURGERY)

 


Urgent telephone call to Ophthalmology for consideration of Temporal Artery Biopsy (VIA OPHTHALMOLOGY)

Simultaneous urgent SCI referral to Rheumatology – will be seen within 2 weeks for follow up

 

 

Editorial Information

Last reviewed: 16/09/2024

Next review date: 16/09/2026

Author(s): Lucy Moran.

Version: 1

Reviewer name(s): Fergus Donachie.