RCP Medicine Podcast Episode 91: Giant cell arteritis
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Sep 27, 2025 Rik Patel, a Consultant rheumatologist and general physician with expertise in large vessel vasculitis, shares insights on giant cell arteritis. He discusses a complex case featuring a 70-year-old patient with headaches and systemic symptoms. Key topics include interpreting headache patterns, the overlap with polymyalgia rheumatica, and the significance of visual symptoms. Rik emphasizes the role of fast-track pathways for diagnosis and treatment, and highlights new treatments like tocilizumab that have transformed patient outcomes.
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Use CTA To Define Large-Vessel Stenosis
- Use CT angiography to map extracranial large-vessel stenosis when claudication suggests axillary/subclavian involvement.
- Identify lesions that might require vascular intervention or explain limb ischemia.
PET Scans For Occult Large-Vessel Disease
- PET scans excel at detecting large-vessel inflammation when cranial features are absent and malignancy workup is negative.
- PET is useful for otherwise unexplained systemic inflammation suggesting aortitis or large-vessel GCA.
Reserve Biopsy For Discordant Cases
- Reserve temporal artery biopsy for discordant cases: low clinical probability with positive ultrasound or high clinical suspicion with negative ultrasound.
- Use biopsy selectively as part of cumulative diagnostic synthesis alongside clinical and imaging data.