Editing Giant cell arteritis (section)

==Diagnosis==

===Physical exam===
* Palpation of the head reveals prominent [[Superficial temporal artery|temporal arteries]] with or without pulsation.<ref name="auto">{{cite web |url=https://www.lecturio.com/concepts/giant-cell-arteritis/| title=Giant Cell Arteritis
|website=The Lecturio Medical Concept Library | date=26 November 2020
|access-date= 23 July 2021}}</ref>
* The [[Temporal bone|temporal area]] may be tender.<ref name="auto"/>
* Decreased pulses may be found throughout the body<ref name="auto"/>
* Evidence of [[ischemia]] may be noted on fundal exam.<ref name="auto"/>
* [[Bruit]]s may be heard over the [[Subclavian artery|subclavian]] and [[Axillary artery|axillary]] arteries<ref name="auto"/>
[[File:Giant cell arteritis -- intermed mag.jpg|thumb|Intermediate magnification [[micrograph]] showing giant cell arteritis in a [[Superficial temporal artery|temporal artery]] biopsy. The arterial lumen is seen on the left. A giant cell is seen on the right at the interface between the thickened [[Tunica intima|intima]] and [[Tunica media|media]].  [[H&E stain]]]]

===Laboratory tests===
* [[Erythrocyte sedimentation rate]],<ref name=BSR2020/> an inflammatory marker, >60&nbsp;mm/hour (normal 1–40&nbsp;mm/hour)
* [[C-reactive protein]], another inflammatory marker, may be elevated<ref name=BSR2020/>
* LFTs, [[liver function tests]], are abnormal particularly raised ALP- [[alkaline phosphatase]]
* [[Platelets]] may also be elevated

===Biopsy===
[[File:Cerebral Giant-Cell Vasculitis.jpg|thumb|Histopathology of giant cell vasculitis in a cerebral artery. Elastica-stain.]]
The [[Gold standard (test)|gold standard]] for diagnosing temporal arteritis is [[biopsy]], which involves removing a small part of the vessel under local anesthesia and examining it [[microscope|microscopically]] for [[giant cell]]s infiltrating the tissue.<ref>{{cite journal | vauthors = Cahais J, Houdart R, Lupinacci RM, Valverde A | title = Operative technique: Superficial temporal artery biopsy | journal = Journal of Visceral Surgery | volume = 154 | issue = 3 | pages = 203–207 | date = June 2017 | pmid = 28601496 | doi = 10.1016/j.jviscsurg.2017.05.001 | doi-access =  }}</ref> However, a [[false negative|negative result]] does not definitively rule out the diagnosis; since the [[blood vessel]]s are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. Unilateral biopsy of a 1.5–3&nbsp;cm length is 85-90% sensitive (1&nbsp;cm is the minimum).<ref>{{cite journal | vauthors = Ypsilantis E, Courtney ED, Chopra N, Karthikesalingam A, Eltayab M, Katsoulas N, Tang TY, Ball RY | title = Importance of specimen length during temporal artery biopsy | journal = The British Journal of Surgery | volume = 98 | issue = 11 | pages = 1556–1560 | date = November 2011 | pmid = 21706476 | doi = 10.1002/bjs.7595 | s2cid = 20149393 }}</ref> Characterised as intimal hyperplasia and medial granulomatous inflammation with elastic lamina fragmentation with a CD4+ predominant T cell infiltrate, currently biopsy is only considered confirmatory for the clinical diagnosis, or one of the diagnostic criteria.<ref name="pmid21176820"/>

===Medical imaging===
Radiological examination of the temporal artery with [[ultrasound]] yields a [[halo sign]]. Contrast-enhanced brain [[Magnetic resonance imaging|MRI]] and [[CT scan|CT]] are generally negative in this disorder. Recent studies have shown that 3T MRI using super high resolution imaging and contrast injection can non-invasively diagnose this disorder with high specificity and sensitivity.<ref name="pmid17885247">{{cite journal | vauthors = Bley TA, Uhl M, Carew J, Markl M, Schmidt D, Peter HH, Langer M, Wieben O | title = Diagnostic value of high-resolution MR imaging in giant cell arteritis | journal = AJNR. American Journal of Neuroradiology | volume = 28 | issue = 9 | pages = 1722–1727 | date = October 2007 | pmid = 17885247 | pmc = 8134183 | doi = 10.3174/ajnr.A0638 | doi-access = free }}</ref> Temporal artery thickening on imaging has been demonstrated to have highest positive [[Likelihood ratios in diagnostic testing|likelihood ratios]] for GCA when compared with other non invasive diagnostic tests.<ref>{{cite journal | vauthors = van der Geest KS, Sandovici M, Brouwer E, Mackie SL | title = Diagnostic Accuracy of Symptoms, Physical Signs, and Laboratory Tests for Giant Cell Arteritis: A Systematic Review and Meta-analysis | journal = JAMA Internal Medicine | volume = 180 | issue = 10 | pages = 1295–1304 | date = October 2020 | pmid = 32804186 | pmc = 7432275 | doi = 10.1001/jamainternmed.2020.3050 }}</ref>

===Early recognition===
Women and men approximately 45 years old and who suffer from several complaints (at least 5 of the 16 symptoms)<ref>{{Cite web |title=Symptomatix Home |url=https://www.symptomatrix-eng.eu/index.htm |access-date=2023-05-07 |website=www.symptomatrix-eng.eu}}</ref> listed below could have giant cell arteritis.

*Fatigue and apathy
* Stiffness in joints and/or muscles   
* Painful jaws when chewing
* Sensitive scalp   
* Physical malaise and/or weakness    
* Bloated arteries of the temples    
* Headaches, migraine    
* Tongue problems       
* Bleakness, depression    
* Changed eyesight    
* Poor or lack of appetite    
* Reduced eyesight, blindness   
* Unusual loss of weight    
* A temperature    
* Unusual perspiration
* Night sweats