Filed under: Heart & Vascular
Giant cell arteritis is an inflammation of the lining of your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis or cranial arteritis.
Giant cell arteritis frequently causes headaches, jaw pain, and blurred or double vision. Blindness and, less often, stroke are the most serious complications of giant cell arteritis.
Prompt treatment of giant cell arteritis is critical in order to prevent permanent tissue damage and loss of vision. Corticosteroid medications usually relieve symptoms of giant cell arteritis and may prevent loss of vision. You'll likely begin to feel better within days of starting your treatment.
The most common symptoms of giant cell arteritis are head pain and tenderness — often severe — that usually occurs in both temples. Some people, however, have pain in only one temple or in the front of the head.
Signs and symptoms of giant cell arteritis can vary. For some people, the onset of the condition feels like the flu — with muscle stiffness and aches (myalgia) around the shoulders and hips, fever and fatigue, as well as headaches.
Generally, signs and symptoms of giant cell arteritis include:
Pain and stiffness in the neck, shoulders or hips are common symptoms of a related disorder, polymyalgia rheumatica. Approximately half the people with giant cell arteritis also have polymyalgia rheumatica.
When to see a doctor
If you develop a new, persistent headache or any of the problems listed above, see your doctor without delay. If you're diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent blindness.
Your arteries are pliable tubes with thick, elastic walls. Oxygenated blood leaves your heart through your body's main artery, the aorta. The aorta then subdivides into smaller arteries that deliver blood to all parts of your body, including your brain and internal organs.
With giant cell arteritis, some of these arteries become inflamed, causing them to swell and sometimes decreasing blood flow. Just what causes these arteries to become inflamed isn't known.
Although almost any large or medium-sized artery can be affected, swelling most often occurs in the temporal arteries in your head, which are located just in front of your ears and continue up into your scalp. In some cases, the swelling affects just part of an artery with sections of normal vessel in between.
Although the exact cause of giant cell arteritis isn't known, several factors can increase your risk, including:
Giant cell arteritis can cause the following complications:
If you have signs and symptoms of giant cell arteritis, you're likely to start by seeing your primary care doctor. In some cases, your doctor may also refer you to an eye specialist (ophthalmologist) if you're having visual symptoms, a brain and nervous system specialist (neurologist) if you're having headaches, or a joint specialist (rheumatologist) if you're having symptoms of polymyalgia rheumatica.
Because appointments can be brief and there may be many things to discuss, it's a good idea to be prepared. Here's some information to help you get ready and what to expect from your doctor.
What you can do
Preparing a list of questions can help you make the most of your time with your doctor and may ensure that you cover all the points that are important to you. For giant cell arteritis, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional questions that come up during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to spend more time on. Your doctor may ask:
What you can do in the meantime
Ask your doctor if taking a pain reliever such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) might help ease head pain or tenderness.
Giant cell arteritis can be difficult to diagnose because its early symptoms resemble those of many common conditions. For this reason, your doctor will try to rule out other possible causes of your problem.
To help diagnose giant cell arteritis, you may have some or all of the following tests:
Blood tests. If your doctor suspects giant cell arteritis, you're likely to have a blood test that checks your erythrocyte sedimentation rate — commonly referred to as the sed rate. This test measures how quickly red blood cells fall to the bottom of a tube of blood. Red cells that drop rapidly may indicate inflammation in your body.
You may also have a test that measures C-reactive protein (CRP), a substance your liver produces when inflammation is present. The same tests may be used to follow your progress during treatment.
Biopsy. The best way to confirm a diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery. Because the inflammation may not occur in all parts of the artery, more than one sample may be needed. The procedure is performed on an outpatient basis during local anesthesia, usually with little discomfort or scarring. The sample is examined under a microscope in a laboratory.
If you have giant cell arteritis, the artery will often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. Unfortunately, a biopsy isn't foolproof. It's possible to have giant cell arteritis and still have a negative biopsy result. If the results aren't clear, your doctor may advise another temporal artery biopsy on the other side of your head.
Although a temporal artery biopsy is the standard test for diagnosing giant cell arteritis, imaging tests may also be used for diagnosing giant cell arteritis and for monitoring treatment. Possible tests include:
Treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.
You should start feeling better within just a few days, but you may need to continue taking medication for one to two years or longer. After the first month, your doctor may gradually begin to lower the dosage until you reach the lowest dose of corticosteroids needed to control inflammation as measured by sed rate and CRP tests. Some of your symptoms may return during this tapering period.
What are corticosteroids?
Corticosteroids are powerful anti-inflammatory drugs whose effects mimic those of hormones produced by your adrenal glands. The drugs can effectively relieve pain, but prolonged use — especially at high doses — can lead to a number of serious side effects.
Older adults, who are most likely to be treated for giant cell arteritis, are particularly at risk of side effects because they're more prone to certain conditions that also may be caused by corticosteroids. These include:
Other possible side effects of corticosteroid therapy include:
To counter the potential side effects of corticosteroid treatment, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. Your doctor is also likely to monitor your blood pressure and may recommend an exercise program, diet changes and medication to keep blood pressure within a normal range. Most side effects go away when the corticosteroid treatment is stopped.
Ask your doctor about taking between 81 and 100 milligrams of aspirin daily (anti-platelet therapy). Taken on a daily basis, aspirin may reduce the risk of blindness and stroke.
When giant cell arteritis is diagnosed and treated early, the prognosis is usually excellent. Your symptoms should improve quickly after beginning corticosteroid treatment, and your vision isn't likely to be affected. Your greatest challenge in this case may be coping with any side effects of your medication. The following suggestions may help:
Learning everything you can about giant cell arteritis and its treatment can help you feel more in control of your condition. Your health care team can answer your questions, and online support groups may also be of help. Know the possible side effects of any medication you take, and report any changes in your health to your doctor.