Problems associated with the diagnosis of GCA

[PMRpro]

In response to a mini-rant I had one day on a forum, I went off for a surfing session and found an article on the Johns Hopkins site with case studies on GCA.

hopkinsmedicine.org/gec/stu...

It is worth going to the link because it describes the history of a few patients and the problems the doctors had in diagnosis and mnagement.

I thought their discussion of the problems associated with diagnosis of GCA was rather telling and worth quoting here for ease of reference:

"GCA is really a systemic illness with many manifestations and a myriad of presentations. It may be associated with coronary artery disease as in Case 1.

Some of the clinical features of GCA (derived in part from Machado reference)and their appromimate prevalence are as follows:

ESR: >50 90%

>100 60%

Headache 70%

Tenderness of arteries 50%

Jaw claudication (predictive:ask) 50%

Bruits (listen to subclavian) 40%

PMR 50%

Alkaline Phosphatase 50%

Artery thickening 45%

No arterial pulse 40%

Visual symptoms: Diplopia 10%

Vision loss 10%

Ultimate Blindness 15%

Weight Loss 40%

Claudication (non-jaw) 20%

Fever 20%

Other less common symptoms are:

Raynaud's

Scalp nodules

Thick occipital artery

Necrosis of the tongue, scalp

Carotid tenderness

Smell/taste abnormalities

Beaded retinal veins

Mononeuropathy

Myocardial infarction (MI), dissecting aneurysm, and cerebrovascular accident (CVA) are potential causes of death in GCA.

(top of page)

Take Home Points

1. GCA is a humbling illness to the clinician, especially for the primary care physician, because it emerges subtly in the patient with typically many other problems.

2. It is a common illness in elders with a myriad of manifestation, often very subtle

3. Recurrence is common, even with ideal treatment

4. Prednisone use in the elderly is very tricky

5. While a potential nightmare for the generalist, GCA is an exciting problem for the medical student because of its variety in presentation and pathology"

extracted from the Johns Hopkins Education site which is available to forward to others by email, print off - even send to Facebook!

And it was their take home points that I really liked! Humbling eh?

Maybe this should be required reading for our GPs and specialists too?

[11caroline29]

Interesting reading especially the 3 cases and their history.

[PMRpro Ambassador in reply to 11caroline29]

Isn't it? Occasionally I do feel sorry for medics ...

[SheffieldJane]

Thank you for your continued exploration. It really makes for the richness of this forum. 🌹

[Hidden]

Another I've just printed off

[SnazzyD]

Humbling 🤨I’m glad we provide “excitement” for the students too.

My Rheumatology Reg said the other week not to worry about any more systemic problems like asymptomatic large vessel vasculitis (so no point in looking) because GCA is a monophasic disease and it won’t happen again. Up to then she did very well.

[PMRpro Ambassador in reply to SnazzyD]

Oh yes? And what gave her that idea? I fear not - and so do better people than her!

[Purplecrow in reply to PMRpro]

What we seem to have here...is a parallel universe...Imagine reading this stuff in 20 years...and being amazed at the beliefs being put forth...

[DorsetLady PMRGCAuk volunteer]

Humbling? Really 🙄Good article though.

[Rugger]

Thank you for this. I'm sure several of us could see some of ourself in those case histories!!

[RoadTrip]

Doesn’t say how they chose the examples, may have been emphasising recurrent nature of disease, otherwise a bit concerning!

[PMRpro Ambassador in reply to RoadTrip]

I imagine they chose case reports to illustrate the challenges they face.

[RoadTrip in reply to PMRpro]

Agreed that the presentation of GCA varied between the examples, might be why everyone is called atypical.

What concerns me is the reoccurrence, understood that it could happen but the implication from these examples is that it is quite frequent.

[Frewen1]

Thanks for this

[Frewen1]

Thanks for this