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Giant Cell Arteritis (GCA) is a form of autoimmune vasculitis (inflammation of blood vessels) that affects large blood vessels in the body, but most commonly arteries in the head area, particularly around the temples. Among other symptoms, it can cause headaches, scalp tenderness, and difficulty chewing your food. Some individuals may also have pain around their shoulders or hips. If not treated, GCA can cause sudden vision problems which in some cases, can be irreversible. This makes quick recognition and treatment of GCA important. GCA is most often first treated with prednisone. For some patients, if they are having difficulty getting off Prednisone, other disease modifying agents may be used. One of the newest treatment options for GCA is tocilizumab (Actemra). While some rheumatologists will use it at the start of treatment with Prednisone, others may wait to see if it is needed depending on how beneficial the Prednisone was. In individual cases, there may be reasons to use it earlier or later.

Raewyn from Canada asks: How does the COVID vaccine impact those with Takayasu disease or other large vessel vasculitis?

When it comes to most of the rheumatic conditions, there have been no indicators to date that the vaccines are unsafe or do harm to your underlying disease. This would include all forms of vasculitis. That is not to say that vaccines do not have risks, but they would be rare, and are not specific to a rheumatic disease. The benefits of vaccine far outweigh their risks. This is particularly the case for those with rheumatic disease, as a COVID infection could be much worse with worse outcomes if you have an active vasculitis. Where things get more complicated is the medications used to treat our conditions, which may decrease the benefit of the vaccine. This is why a 3rd shot of the COVID vaccine has been advocated for successfully for those on most rheumatologic treatments.

Mahdi from Afghanistan asks: My wife was told she has Takayasu’s arteritis, but her tests (ESR, CRP) came back normal. Is this possible?

Takayasu’s arteritis is a form of vasculitis. It is unique in that it affects large blood vessels, and is generally diagnosed in individuals under the age of 40. It causes inflammation in the blood vessels, which can disrupt blood flow, or cause the wall of the blood vessel to become thinner than it should. While markers for inflammation in blood tests can often be elevated in most forms of vasculitis, it is also possible for them to be normal. A normal test does not rule out Takayasu’s arteritis. While not for everyone, in some patients, a normal ESR or CRP may indicate that the disease is not currently active; damage has been done to the blood vessel causing blood flow disruption (no pulse), but smaller blood vessels have developed to provide the necessary blood flow in its place.

Natasha from India asks: Can HIV cause arthritis?

HIV, or Human Immunodeficiency Virus, is a virus that affects the immune system. In some individuals infected with HIV, it can present with musculoskeletal or rheumatic diseases, ranging from fibromyalgia, HIV-related arthritis, vasculitis or psoriatic arthritis. For most of these, treatment of HIV will also effectively treat the arthritis too.

Tamara from Edmonton asks: Do rheumatologists treat Giant Cell Arteritis?

While rheumatologists are often thought of as treating arthritis only, there are many conditions that we treat that can affect other areas of the body. Vasculitis, or inflammation of blood vessels, is an area of expertise for rheumatologists, including Giant Cell Arteritis. Examples of other conditions which can affect other organs besides joints include lupus, scleroderma, polymyalgia rheumatica, myositis, and osteoporosis.

Wendy from the UK asks: Does the treatment of Polymyalgia Rheumatica with steroids prevent Giant Cell Arteritis?

Polymyalgia rheumatica (PMR) and giant cell arteritis, otherwise known as GCA or temporal arteritis, are distinct condition that may present at the same time. Many patients with GCA also will present with PMR, while a smaller proportion of patients with PMR present with GCA. While the treatment for both starts the same – glucocorticoids – the doses are very different. PMR is treated with low dose prednisone, while GCA initially requires high dose prednisone. That said, once on prednisone, the risk of developing GCA, and particularly loss of vision from GCA, drops significantly.