What are the typical features of giant cell arteritis (GCA)? What are the atypical features of GCA and in what proportion of patients can they be seen?
Bhaskar Dasgupta: The typical features of GCA relate to the age, first of all. We normally see GCA occurring in the late 60s or the early 70s, although later on we get more of the ischemic complications. The typical patients are usually women. They usually have a fairly acute onset of their symptoms. Within the last 6 weeks, for example, they will have a severe headache. They often have jaw pain, tongue pain, due to ischemia – lack of blood supply to these vital organs. Sometimes they have what is called constitutional symptoms, which means that they have lost weight over the last few months, they often get night sweats or day sweats – they get sweaty and they may have to change their bed clothes or bed linen – and they get low-grade fever. That is quite common. Often they will have polymyalgia, which is a new-onset pain in both shoulders with stiffness and also in the hips. And then they can have what we call the dreaded ischemic symptoms to the eyes. They can have double vision, blurred vision, or transient loss of vision, and these are all the typical symptoms of GCA.
Sometimes what happens is, the common headache and the scalp tenderness that we see in GCA do not occur. You may have all these other symptoms – weight loss, low-grade fever, night sweats – but you do not have the headache; that can be a feature of what we call large-vessel GCA. Some of these patients have got involvement of the aorta and of the large blood vessels so they can have limb claudication. When they use their hands, they find that there is ischemia.
Basically, we [have] cranial GCA, which is a typical GCA, versus the large-vessel GCA, which is an atypical GCA and can occur in a younger population.