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Common GCA and PMR exam questions for medical finals, OSCEs and MRCP PACES

 

Question 1.

What are the classic presenting features of giant cell arteritis (GCA)?

  • Temporal headache
  • Jaw claudication
  • Scalp tenderness
  • Tenderness and/or thickening of one of the temporal arteries
  • Visual impairment (involvement of ophthalmic artery)
  • Systemic features: anorexia, fever, sweats, malaise

 

Question 2.

What are the ACR diagnostic criteria for giant cell arteritis (GCA)?

  • Age >50 years
  • New onset headache
  • Abnormalities of the temporal arteries on palpation
  • ESR >50 mm/hour
  • Abnormal temporal artery biopsy.
    • The presence of three or more criteria has a sensitivity of 97% and a specificity of 79% for a diagnosis of giant cell arteritis.

 

Question 3.

How would you investigate suspected giant cell arteritis (GCA)?

  • Bloods, CXR, urine dip
  • Temporal artery biopsy
    • Can be done within 14 days of starting steroid treatment but loses sensitivity over time. May be negative due to skip lesions
    • Shouldn’t delay steroids for biopsy
  • PET scan if suspicion of large vessel involvement
    • E.g. Marked systemic features, high inflammatory markers despite steroid treatment
  • Colour duplex of temporal arteries
    • Sensitivity (and negative predictive value) 95%

 

Question 4.

How would you treat giant cell arteritis (GCA)?

  • If no visual involvement: 40-60mg prednisolone OD
    • Symptoms should improve in 7-14 days
    • Taper dose after 1-2 months gradually
      • By 10mg every 2/52 to 20mg, then by 2.5mg every 2-4/52 to 10mg, then by 1mg every 1-2 months
  • Vision loss/amaurosis fugax
    • IV methylprednisolone 500mg-1g od for 3 days
    • Consider 60mg prednisolone PO if established visual loss