Giant Cell Arteritis

Giant Cell Arteritis

Surya V. Seshan, MD

Cross section of a temporal artery shows adventitial, medial, and intimal active arteritis image with occlusive changes. Numerous multinucleated giant cells are noted within the wall.

MR angiogram shows an irregular, long-segment stenosis of the left common carotid artery image and brachiocephalic artery stenosis image due to mural thickening. These findings are typical of GCA.



  • Giant cell arteritis (GCA)


  • Temporal arteritis

  • Cranial arteritis

  • Horton syndrome


  • Chapel Hill Consensus Conference

    • Granulomatous arteritis of aorta and its major branches, with predilection for extracranial branches of carotid artery

    • Often involves temporal artery

    • Usually occurs in patients > 50 years of age and is often associated with polymyalgia rheumatica

  • American College of Rheumatology Criteria

    • Age ≥ 50 years

    • New onset of localized headache

    • Temporal artery tenderness or decreased temporal artery pulse

    • Elevated ESR ≥ 50 mm/hr

    • Biopsy of artery with necrotizing arteritis with mononuclear infiltrates or granulomatous process

    • Presence of any 3 or more of above yields high sensitivity and specificity


Environmental Exposure

  • Etiology unknown

  • Possible triggers include exposure to several upper respiratory disease pathogens

    • Mycoplasma/Chlamydia pneumoniae

    • Parvovirus B19, human parainfluenza virus type I

    • Herpes simplex virus


  • Associated with HLA-DRB1 and HLA-DR4 gene alleles

  • ICAM-1 gene polymorphism (R241)


  • Autoimmune cell-mediated mechanism

    • T-cell mediated process

      • CD4(+) T-helper cells in inflammatory site

      • T-cell activation locally in arterial wall following activation of antigen presenting cells (e.g., dendritic cells in adventitia)

    • Activation of monocytes/macrophages responsible for systemic symptom

    • Destructive vascular inflammation may lead to vaso-occlusive intimal proliferation or aneurysm formation depending on type of arterial vessel involved

    • Interferon gamma produced from T cells is crucial in giant cell reaction in GCA

  • Role for humoral-mediated immunity is suggested

    • Elevated serum immunoglobulins

    • Detection of circulating immune complexes

    • Rare immune complex deposition



Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Giant Cell Arteritis
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