TY - JOUR
T1 - High risk and low prevalence diseases
T2 - Giant cell arteritis
AU - Lacy, Aaron
AU - Nelson, Rachel
AU - Koyfman, Alex
AU - Long, Brit
N1 - Funding Information:
SN, MB, BL, and AK conceived the idea for this manuscript and contributed substantially to the writing and editing of the review. This manuscript did not utilize any grants, and it has not been presented in abstract form. This clinical review has not been published, it is not under consideration for publication elsewhere, its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. This review does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or SAUSHEC EM Residency Program.
Publisher Copyright:
© 2022
PY - 2022/8
Y1 - 2022/8
N2 - Introduction: Giant cell arteritis (GCA) is a serious condition that carries with it a high rate of morbidity. Objective: This review highlights the pearls and pitfalls of GCA in adult patients, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Discussion: GCA is an immune-mediated vasculitis of medium-sized vessels that primarily affects those over the age of 50 years. Patients can present with a variety of signs and symptoms, including headache, vision changes, and systemic findings such as fever. Findings including jaw and limb claudication, vision changes, and temporal artery abnormalities are specific for diagnosis. While there are no highly sensitive features of the history and examination, the disease should be suspected in patients over the age of 50 years with vision changes, new headache, temporal artery abnormalities, or jaw claudication, especially in the setting of systemic symptoms. Inflammatory markers including erythrocyte sedimentation rate and c-reactive protein in combination are sensitive but not specific for GCA. Delay in diagnosis is associated with vision loss and other complications including aortitis. If suspected, the emergency physician should administer steroids and consult the ophthalmology and rheumatology specialists. Conclusions: An understanding of GCA can assist emergency clinicians in diagnosing and managing this potentially dangerous disease.
AB - Introduction: Giant cell arteritis (GCA) is a serious condition that carries with it a high rate of morbidity. Objective: This review highlights the pearls and pitfalls of GCA in adult patients, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. Discussion: GCA is an immune-mediated vasculitis of medium-sized vessels that primarily affects those over the age of 50 years. Patients can present with a variety of signs and symptoms, including headache, vision changes, and systemic findings such as fever. Findings including jaw and limb claudication, vision changes, and temporal artery abnormalities are specific for diagnosis. While there are no highly sensitive features of the history and examination, the disease should be suspected in patients over the age of 50 years with vision changes, new headache, temporal artery abnormalities, or jaw claudication, especially in the setting of systemic symptoms. Inflammatory markers including erythrocyte sedimentation rate and c-reactive protein in combination are sensitive but not specific for GCA. Delay in diagnosis is associated with vision loss and other complications including aortitis. If suspected, the emergency physician should administer steroids and consult the ophthalmology and rheumatology specialists. Conclusions: An understanding of GCA can assist emergency clinicians in diagnosing and managing this potentially dangerous disease.
KW - Giant cell arteritis
KW - Rheumatology
KW - Temporal arteritis
KW - Vision loss
UR - http://www.scopus.com/inward/record.url?scp=85131594190&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2022.05.042
DO - 10.1016/j.ajem.2022.05.042
M3 - Review article
C2 - 35688119
AN - SCOPUS:85131594190
SN - 0735-6757
VL - 58
SP - 135
EP - 140
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -