Large Vessel GCA — SCE Rheumatology MCQ

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ModerateVasculitisLarge Vessel GCASCE Rheumatology

A 48-year-old woman with known GCA on tapering Prednisolone develops new bilateral upper limb claudication with diminished pulses. CT angiography shows smooth concentric wall thickening of both subclavian arteries. What has developed?

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Correct answer: E — Extracranial large-vessel GCA

GCA can affect extra-cranial large vessels (aorta, subclavian, axillary, carotid arteries) in addition to the superficial temporal arteries. Up to 50% of GCA patients have large vessel involvement. The smooth concentric wall thickening on CTA is characteristic of inflammatory vasculitis rather than atherosclerosis (which shows eccentric calcified plaques). BSR 2020 GCA guidelines recommend monitoring for large vessel complications. Aortic aneurysm and dissection are long-term risks. Treatment involves intensification of immunosuppression and consideration of Tocilizumab.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/musculoskeletal-conditions