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What is Giant Cell Arteritis?

Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is an autoimmune condition that causes inflammation in both large and medium sized blood vessels, a process called vasculitis. GCA interrupts blood flow and can cause pain, inflammation, tenderness around the temples.  In some people, it can cause blindness or partial loss of vision so it is important to start treatment quickly. Some blood vessels are more likely to be affected than others. The temporal artery (on the sides of the head) and the aorta (in the chest) are most commonly affected blood vessels in GCA.

 What causes GCA?

GCA is caused by an over-active immune system which attacks the blood vessel walls and causes them to swell and become narrower.  Less blood can flow through these inflamed and narrow vessels. We do not know what triggers GCA.  Some factors that are thought to contribute to its development are your age, genes, and environment.

 Who is affected by GCA?

GCA affects adults over the age of 50 years with most patients being between the age of 70 to 80.  Females are more often affected than males (3:1.) People with Polymyalgia Rheumatica (PMR) have a higher risk of having GCA.

 What symptoms should you look out for?

GCA can cause different symptoms in different people, but the most common symptoms are:

• New onset headache that is different from previous headaches
• Tender scalp
• Jaw or tongue pain with chewing that is relieved with rest
• Unexplained fever, weight loss, night sweats and fatigue
• Sudden vision loss or double vision

 How is it diagnosed?

1. Physical Examination: swollen temporal artery, tenderness to temple or scalp, loss of pulses in arms or temples, specialty eye exams.
2. Blood Tests: Inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) will be elevated in most but not all patients. There are no antibodies to diagnose GCA.
3. Biopsy: During a temporal artery biopsy, a small sample of the temporal artery, which is located near the temple area of the head, is taken for examination. The sample will be assessed for any inflammation within the artery. The procedure is typically performed under local anesthesia, meaning you will be awake, but the area will be numbed to minimize discomfort.

4. Imaging:

   1. Temporal Artery Ultrasound creates a picture of the temporal arteries and can show inflammation in these vessels.
   2. Positron Emission Tomography (PET) Scan a small amount of a tracer will be injected into the arm through an IV. Then, a special camera creates a picture to see inflammation in the large arteries of the neck, chest, abdomen and legs, and muscles.

 What treatments are available and how long will I take them for?

1. Steroids (Prednisone): For patients presenting with GCA, the first step is high dose prednisone with the goal of dampening the immune system quickly to relieve symptoms and prevent vision loss. Most patients will start to feel a lot better with this treatment within the first 2 weeks. If used on its own, prednisone is usually tapered slowly over 1 to 2 years.
2. Steroid-sparing agents: These medications also reduce inflammation but are slower to take effect. They are used in combination with prednisone to allow a faster taper of the prednisone (usually over months instead of years.) These medications are then continued for 1 year, or sometimes longer.  They generally have fewer side effects than prednisone in the long term.  Examples of these are tocilizumab and methotrexate.

 Other than treatment, what else can I do?

• Regular blood tests: Your physician will use these to monitor your body’s response to treatment.
• Follow up visits: book follow up visits with your physician and inform them of new or worsening symptoms.
• Stay Active: Exercise is good for bone health and protects from muscle weakness which may occur because of the medications you are taking. Start slowly and listen to your body.
• Take vitamin D 1000 to 2000 IU daily to help protect your bones.

Practice good handwashing to keep yourself healthy.