Criteria for identifying GCA in different clinical situations

Can the available criteria for giant cell arteritis (GCA) be used to identify GCA in all clinical situations? What should we focus on?

Bhaskar Dasgupta: No, I do not think so because the conventional criteria are oriented towards cranial GCA – the people who have headaches. It is the conventional American College of Rheumatology (ACR) 1990 criteria that will identify it.

To identify this wider-spectrum large-vessel GCA, we need to widen the symptoms from just headache to symptoms of tongue and jaw pain, to symptoms of visual changes – double vision, blurred vision, and so on – [and] constitutional symptoms; we need to add that in. In addition to the erythrocyte sedimentation rate (ESR), which is in the conventional criteria, we want to add in the C-reactive protein, which is now done in most parts of Europe, for example, rather than the ESR.

Of course, in the conventional criteria, the main form of diagnosis was temporal artery biopsy. You took a sample of the temporal artery, looked at it under the microscope, and made a diagnosis of GCA. But now we have very exciting imaging modalities such as ultrasound, computed tomography (CT) scan, computed tomographic angiography (CTA), positron emission tomography–computed tomography (PET-CT), magnetic resonance angiography (MRA). We need to add these imaging criteria to the temporal artery biopsy to make a diagnosis of GCA.