GPAtlas🧭 When to suspect
Giant cell arteritis (GCA), also called temporal arteritis, is a large-vessel vasculitis (inflammation of artery walls) that almost only affects people over 50. It is a medical emergency: untreated, the inflammation can occlude the arteries supplying the eye and brain, causing sudden, irreversible blindness from anterior ischaemic optic neuropathy (AION – loss of blood supply to the optic nerve head) or stroke. Most sight loss happens before treatment, or in the first few days, which is why recognition and immediate treatment matter so much.
It is the commonest primary vasculitis in adults (around 20 per 100,000 per year in those over 50), with a mean age at onset of about 73, a female-to-male ratio of roughly 2.5:1, and a strong link with polymyalgia rheumatica (PMR – an inflammatory condition causing shoulder and hip girdle pain and stiffness): around half of GCA patients have PMR symptoms.
The two clinical skills in primary care are simple to state: recognise the pattern and treat on suspicion – never waiting for biopsy or blood results – and escalate any visual symptom the same day, because the second eye is at imminent risk and lost vision rarely returns.
| Cranial features | Systemic & large-vessel features |
|---|---|
|
• New-onset headache, usually temporal (over the side of the forehead) and unlike any previous headache |
• PMR symptoms – shoulder and hip girdle pain and morning stiffness (present in about half) |
|
• Jaw or tongue claudication – cramping pain on chewing that eases with rest (the single most specific feature) |
• Constitutional symptoms – fever, night sweats, weight loss, fatigue |
|
• Scalp tenderness – pain combing hair, wearing glasses, or resting on a pillow |
• Large-vessel involvement – limb claudication, bruits, or asymmetric pulses/blood pressure |
|
• Visual symptoms – transient loss (amaurosis fugax), double vision (diplopia), or sudden permanent loss |
• Age over 50 (peak 70–80); commonest in people of White European origin |
Source: BSR 2020
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