Giant Cell Arteritis (Temporal Arteritis)
Giant Cell Arteritis (Temporal Arteritis)
Giant cell arteritis (GCA), also known as temporal arteritis, is an inflammatory autoimmune disease affecting large and medium-sized arteries, most commonly those in the head and temples. It causes inflammation of the arterial walls, leading to narrowing and reduced blood flow, which can result in serious complications such as vision loss.
Causes and Risk Factors
- The exact cause is unknown but involves an abnormal immune response attacking arterial walls.
- Genetic and environmental factors may increase susceptibility.
- It predominantly affects adults over 50 years old, more commonly women and people of Northern European descent.
Symptoms
- Headache: New, persistent, often severe, typically localized around the temples but can be diffuse.
- Scalp tenderness: Pain when touching or combing hair.
- Jaw claudication: Pain or fatigue in jaw muscles during chewing.
- Vision problems: Blurred vision, double vision (diplopia), transient vision loss (amaurosis fugax), or sudden permanent vision loss.
- Systemic symptoms: Low-grade fever, fatigue, malaise, weight loss, sweats.
- Polymyalgia rheumatica (PMR): About 50% of patients have PMR, characterized by pain and stiffness in shoulders, neck, and hips.
- Other symptoms: Tongue pain or necrosis, limb claudication, strokes or transient ischemic attacks if other arteries are involved.
Complications
- Vision loss: Due to ischemic optic neuropathy from involvement of ophthalmic or posterior ciliary arteries; can be sudden and irreversible if untreated.
- Aortic aneurysm and dissection: Late complications from inflammation of the aorta, requiring monitoring.
- Stroke: From involvement of carotid or vertebrobasilar arteries.
Diagnosis
- Clinical evaluation: Based on symptoms and physical exam (tender temporal artery, diminished pulse).
- Blood tests: Elevated inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
- Temporal artery biopsy: Gold standard for diagnosis, showing characteristic granulomatous inflammation with multinucleated giant cells.
- Imaging: Ultrasound of temporal arteries or MRI/CT angiography for large vessel involvement.
- Differential diagnosis: Rule out other causes of headache and vision loss.
Treatment
- Immediate corticosteroid therapy: High-dose prednisone or equivalent to reduce inflammation and prevent vision loss; treatment often started before biopsy results due to urgency.
- Tapering steroids: Gradual dose reduction over months to years, monitoring for relapse.
- Adjunctive therapies: Low-dose aspirin to reduce ischemic complications; immunosuppressive agents (e.g., tocilizumab) may be used in refractory cases.
- Monitoring: Regular follow-up for symptom control, side effects of steroids, and screening for aortic complications.
Prognosis
- Prompt treatment usually leads to rapid symptom improvement and prevents blindness.
- Relapses are common, especially when steroid doses are lowered.
- Long-term complications include steroid side effects and vascular complications such as aortic aneurysm.
Summary Table
| Aspect | Details |
|---|---|
| Definition | Autoimmune inflammation of large/medium arteries, especially temporal arteries |
| Typical Age Group | Adults >50 years, more common in women |
| Key Symptoms | New headache, scalp tenderness, jaw claudication, vision changes, systemic symptoms |
| Associated Condition | Polymyalgia rheumatica (in ~50% of cases) |
| Diagnosis | Clinical signs, elevated ESR/CRP, temporal artery biopsy, imaging |
| Treatment | High-dose corticosteroids, aspirin, immunosuppressants in refractory cases |
| Major Complications | Vision loss, aortic aneurysm/dissection, stroke |
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References
- Cleveland Clinic: Giant Cell Arteritis (Temporal Arteritis)1
- Mayo Clinic: Giant Cell Arteritis – Symptoms and Causes2
- Vejthani Hospital: Giant Cell Arteritis Overview3
- MSD Manuals: Giant Cell Arteritis – Musculoskeletal Disorders4
- Wikipedia: Giant Cell Arteritis5
- Johns Hopkins Vasculitis Center: Giant Cell Arteritis6
- American College of Rheumatology: Giant Cell Arteritis7
- Better Health Channel: Eyes – Giant Cell Arteritis8
Giant cell arteritis is a medical emergency due to the risk of sudden vision loss. Early recognition and prompt corticosteroid treatment are critical to prevent irreversible complications.
