ACP Internist discusses the challenges of a differential diagnosis of Giant-Cell Arteritis (GCA) according to experts including HSS rheumatology fellow Sebastian Sattui, MD, MS, as many conditions can mimic it.

Patients may present with constitutional symptoms like fever, weight loss, fatigue, or night sweats, but also ischemic symptoms caused by impaired blood flow such as headaches, scalp tenderness, or jaw claudication. “A lot of the descriptions of the disease say that it is most commonly reported in White people, but there are reports in other races as well,” said Dr. Sattui. The wide variety of symptoms can lead to delay in diagnosis, he added.

The American College of Rheumatology (ACR) is currently working on updated guidelines for GCA diagnosis and management, but evaluation of any patient with suspected GCA should include a comprehensive history and physical examination, with focused vascular examination, noted Dr. Sattui.

Dr. Sattui advised patients with a high suspicion of GCA, especially those with threatened visual loss, should start treatment as soon as possible, with a biopsy scheduled shortly thereafter. In addition to steroids, the treatment of GCA has recently expanded to include immunosuppressive drugs, like the IL-6 receptor antibody tocilizumab. “Specialists are best positioned to know who is a good candidate for tocilizumab,” noted Dr. Sattui. He underscored the importance of good communication with primary care physicians throughout the process. “Patients who are on high doses of steroids as part of their treatment may have side effects such as diabetes, hypertension, or fractures (osteoporosis),” explained Dr. Sattui. “This requires close comanagement between primary care and a rheumatologist.”

Read the full article at ACPinternist.org.