Description

Giant cell arteritis is an inflammation of the lining of the arteries. Most often, it affects the arteries of the head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis.

Giant cell arteritis frequently causes headaches, scalp tenderness, jaw pain and vision problems. Not treated, it can lead to blindness.

Prompt treatment with corticosteroids usually relieves the symptoms of giant cell arteritis and could prevent vision loss. It is likely that you begin to feel better within a few days of starting treatment. But even with treatment, relapses are common.

You will need to visit your doctor regularly for check-ups and treatment of the side effects of taking steroids.

Symptoms

The most common symptoms of giant cell arteritis are headache and sensitivity — often severe, which usually affects both temples. Head pain can grow progressively worse, going back and forth, or disappear temporarily.

In general, the signs and symptoms of giant cell arteritis include:

  • Persistent and severe headache, usually in the area of the temple
  • Scalp tenderness
  • Pain in the jaw when chewing or opening the mouth
  • Fever
  • Fatigue
  • Unintentional weight loss
  • The loss of vision or double vision, particularly in people who also have pain in the jaw
  • Sudden, permanent loss of vision in one eye

Pain and stiffness in the neck, shoulders or hips are common symptoms of a disorder associated with polymyalgia rheumatica. About 50 percent of 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 signs and symptoms listed above, see your doctor without delay. If you are diagnosed with giant cell arteritis, start the treatment as soon as possible can help prevent vision loss.

Causes

With giant cell arteritis, the lining of the arteries are inflamed, causing swelling. This swelling narrows the blood vessels, reducing the amount of blood and therefore oxygen and vital nutrients — that reaches the tissues of your body.

Almost all large or medium-sized artery can be affected, but the swelling most commonly occurs in the arteries in the temples. These are just in front of the ears and continue on your scalp.

The causes of these arteries to become inflamed it is not known, but is thought to involve abnormal attacks against the walls of the arteries by the immune system. Certain genes and environmental factors may increase the susceptibility to the disease.

Risk factors

There are several factors that may increase your risk of developing giant cell arteritis, including:

  • Age. Giant cell arteritis affects only to adults, and rarely the age of 50. Most people with this condition develop signs and symptoms between the ages of 70 and 80.
  • Sex. Women are two times more likely to develop the disease than men.
  • Race and geographic region. Giant cell arteritis is more common among white people in populations of Northern european or Scandinavian ancestry.
  • Polymyalgia rheumatica. Have polymyalgia rheumatica puts you at higher risk of developing giant cell arteritis.
  • The history of the family. Sometimes, the condition runs in families.

Complications

Giant cell arteritis can cause serious complications, including:

  • Blindness. Decreased blood flow to the eyes can cause a sudden, painless loss of vision in one or, rarely, the two eyes. The vision loss is usually permanent.
  • Aneurysm of the aorta.An aneurysm is a bulge that forms in a weakened blood vessel, usually in the large artery that runs down the center of your chest and abdomen (aorta). An aortic aneurysm may burst and cause life-threatening internal bleeding. Due to this complication can occur even years after the diagnosis of giant cell arteritis, your doctor may monitor the aorta with an annual volume of chest X-rays or other imaging tests, such as ultrasound andCT.
  • Stroke. This is a rare complication of giant cell arteritis.

Aneurysm of the aorta. An aneurysm is a bulge that forms in a weakened blood vessel, usually in the large artery that runs down the center of your chest and abdomen (aorta). An aortic aneurysm may burst and cause life-threatening internal bleeding.

Due to this complication can occur even years after the diagnosis of giant cell arteritis, your doctor may monitor the aorta with an annual volume of chest X-rays or other imaging tests, such as ultrasound and CT .

Diagnosis

Giant cell arteritis can be difficult to diagnose because its early symptoms resemble those of other common diseases. For this reason, your doctor will try to rule out other possible causes of your problem.

In addition to asking about your symptoms and medical history, your doctor is likely to perform a thorough physical examination, paying special attention to their temporal arteries. Often, one or both of these arteries are tender, with a reduced pulse and a hard, cordlike feel and appearance.

Your doctor may also recommend certain lab tests.

Blood tests

The following tests can be used to help diagnose your condition and to follow its evolution during the treatment.

  • The erythrocyte sedimentation rate. It is commonly known as the sedimentation rate, this test measures the speed at which red blood cells fall to the bottom of a tube of blood. The red blood cells, which drop rapidly could indicate inflammation in your body.
  • The C-reactive protein (CRP). This measures a substance that the liver produces when inflammation is present.

Imaging tests

These can be used to diagnose giant cell arteritis and to monitor the response to treatment. Tests may include:

  • The Doppler ultrasound. This test uses sound waves to produce images of the blood flowing through the blood vessels.
  • The magnetic resonance angiography (MRA). This test combines a magnetic resonance imaging with use of a contrast material that produces detailed images of the blood vessels. Let your doctor know ahead of time if you feel uncomfortable being confined in a small space due to which the test is carried out in a tube in the form of machine.
  • Positron emission tomography (PET). If your doctor suspects that you might have giant cell arteritis in the large arteries, as the aorta, he or she may recommend a PET . This test uses an intravenous tracer solution containing a small amount of radioactive material. A pet scan can produce detailed images of the large blood vessels and to highlight areas of inflammation.

Biopsy

The best way to confirm the diagnosis of giant cell arteritis is by taking a small sample (biopsy) of the temporal artery. This artery is found close to the skin just in front of the ears and continues up to the scalp. The procedure is performed on an outpatient basis with local anesthesia, usually with a little bit of discomfort or scarring. The sample is examined under a microscope in a laboratory.

If you have giant cell arteritis, the artery often show inflammation that includes abnormally large cells, called giant cells, which give the disease its name. It is possible to have giant cell arteritis and have a negative biopsy result.

If the results are not clear, your doctor may advise another biopsy of the temporal artery on the other side of his head.

Treatment

The main treatment of giant cell arteritis is composed of high-dose corticosteroid medicines such as prednisone. Due to that immediate treatment is necessary to prevent the loss of vision, your doctor is likely that the initiation of the medication, even before confirming the diagnosis with a biopsy.

It is likely that you begin to feel better within a few days of starting treatment. If you have visual loss before treatment with corticosteroids, it is unlikely that the vision will improve. However, his good eye might be able to offset some of the visual changes.

You may need to continue taking medication for one to two years or more. After the first month, your doctor may slowly begin to lower the dose until you reach the minimum dose of corticosteroids needed to control the inflammation.

Some of the symptoms, especially headaches, you may return during this waning period. This is the point at which many people also develop symptoms of polymyalgia rheumatica. Such eruptions can usually be treated with a slight increase in the dose of corticosteroids. Your doctor may also suggest an immunosuppressive drug called methotrexate (Trexall).

Corticosteroids can cause serious side effects, such as osteoporosis, high blood pressure, and muscle weakness. To counteract the possible side effects, 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.

The Food and Drug Administration recently approved tocilizumab (Actemra) for the treatment of giant cell arteritis. It is given as an injection under the skin. Side effects include making you more prone to infections. More research is needed.

Lifestyle and home remedies

When giant cell arteritis is diagnosed and treated early, the prognosis is usually excellent. Your symptoms will likely improve quickly after starting treatment with corticosteroids, and their vision is not likely to be affected.

The following tips can help you manage your condition and to deal with the side effects of the medication:

  • Eat a healthy diet.Eating well can help prevent potential problems, such as thinning of the bones, high blood pressure and diabetes. The emphasis on fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting the salt, sugar, and alcohol. Make sure you get enough calcium and vitamin D. Experts recommend 1,200 milligrams (mg) of calcium and 800 international units (IU) of vitamin D a day for women over age 50 and men older than 70 years. Check with your doctor to see what dose is right for you.
  • Exercise regularly.Regular aerobic exercise, such as walking, can help prevent bone loss, high blood pressure and diabetes. It is also beneficial for the heart and the lungs. In addition, many people find that exercise improves your mood and overall sense of well-being. If you're not used to exercising, start slowly and gradually increase. Your doctor can help you plan an exercise program.
  • Get checkups. See your doctor regularly to check for treatment side effects and the development of complications.
  • Ask about aspirin. Ask your doctor about taking between 75 and 150 mg of aspirin every day. Taken daily, low-dose aspirin might reduce the risk of blindness, and stroke.

Eat a healthy diet. Eating well can help prevent potential problems, such as thinning of the bones, high blood pressure and diabetes. The emphasis on fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting the salt, sugar, and alcohol.

Make sure you get enough calcium and vitamin D. Experts recommend 1,200 milligrams (mg) of calcium and 800 international units (IU) of vitamin D a day for women over age 50 and men older than 70 years. Check with your doctor to see what dose is right for you.

Exercise regularly. Regular aerobic exercise, such as walking, can help prevent bone loss, high blood pressure and diabetes. It is also beneficial for the heart and the lungs. In addition, many people find that exercise improves your mood and overall sense of well-being.

If you're not used to exercising, start slowly and gradually increase. Your doctor can help you plan an exercise program.

Coping and support

Learn everything you can about the giant cell arteritis and its treatment can help you feel more in control of their condition. Your health care team can answer your questions, and online support groups can also be of help. Learn about the possible side effects of the medications you take, and report any changes in your health with your doctor.

Preparing for your appointment

You could start by seeing your primary care physician. He or she may refer you to an eye specialist (ophthalmologist) if you are having visual symptoms, a brain and nervous system specialist (neurologist) if you are having headaches, or a specialist in diseases of the joints, bones and muscles (rheumatologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there is something that you need to do beforehand. For some tests involved in the diagnosis of giant cell arteritis, you may need to follow special instructions prior to your appointment.

Make a list of:

  • Its symptoms, including those that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including any major stresses or recent life changes
  • All the drugs, vitamins, and other supplements you are taking, including dose
  • Questions to ask your doctor

Bring a friend or family member with you to help you remember the information they give you.

For giant cell arteritis, questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • What are other possible causes?
  • What tests are needed?
  • What are my treatment options?
  • What side effects can I expect from the medicine?
  • How long should I stay on the medication, and what is my long-term prognosis?
  • Is giant cell arteritis back?
  • I have these other health conditions. How can I best manage them together?
  • Do I have to change my diet? Do I need to take supplements?
  • Do you have brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you a series of questions, such as:

  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Ask your doctor if you are taking a pain reliever such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can help relieve headache pain or tenderness.

Symptoms and treatment of Giant cell arteritis