Giant Cell Arteritis

Giant cell arteritis (GCA), or temporal arteritis, is an inflammatory disease affecting the large blood vessels of the scalp, neck and arms. Inflammation causes a narrowing or blockage of the blood vessels, which interrupts blood flow. The disease is commonly associated with polymyalgia rheumatica.

Caucasian women over the age of 50 – most commonly between the ages of 70 and 80 years – have the highest risk of developing giant cell arteritis. Although women are more likely than men to develop GCA, research suggests that men are more likely to suffer potentially blinding eye involvement.

The cause of GCA is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks the blood vessels, including the temporal arteries, which supply blood to the head and the brain. Genetic and environmental factors (such as infections) are thought to play important roles. Because it is rare in people under age 50, its development could be linked to the aging process.

Early symptoms of giant cell arteritis may resemble flu symptoms such as fatigue, loss of appetite and fever. Symptoms specifically related to the inflamed arteries of the head include:

• Headaches, often severe.
• Tenderness of the scalp or temples.
• Double vision.
• Temporary or sustained vision loss (like having a curtain pulled partly over the eye).
• Dizziness or problems with coordination and balance.
• Jaw pain when eating or talking.
• Persistent sore throat or difficulty swallowing.
• Occasional chest pain.

A diagnosis of giant cell arteritis is based largely on symptoms and a physical examination. The exam may reveal that the temporal artery is inflamed and tender to the touch, and that it has a reduced pulse.

A temporal artery biopsy is done if the physical exam suggests GCA. This involves removing a tiny piece of tissue from above and in front of the ear and examining it under a microscope. A biopsy that is positive for giant cell arteritis will show abnormal cells in the artery walls. Sometimes more than one biopsy may be necessary to make the diagnosis.

Prompt treatment with high doses of corticosteroids reduces the small but definite risk of blindness. As with polymyalgia rheumatica, the symptoms of giant cell arteritis quickly disappear with treatment, but corticosteroid therapy may be necessary for months to years to keep the inflammation down.

Sometimes GCA may be treated with other immune-suppressing drugs such as methotrexate.

Once symptoms disappear and inflammatory markers in the blood are normal, the risk of blindness is greatly reduced. Proper nutrition, physical activity, rest, and following the prescribed medication regimen are important for managing the condition and combating any possible side-effects of corticosteroid therapy. GCA has been linked to an increased risk of aneurysms (a ballooned and weakened area of an artery), which can occur years after diagnosis. Doctors and caregivers should be aware of this possibility.