GIANT CELL ARTERITIS
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.
SYMPTOMS
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:
Persistent, severe head pain and tenderness, usually in your temple area
Vision loss or double vision
Scalp tenderness — it may hurt to comb your hair or even to lay your head on a pillow, especially where the arteries are inflamed
Jaw pain (jaw claudication) when you chew or open your mouth wide
Sudden, permanent loss of vision in one eye
Fever
Unexplained weight loss
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.
CAUSES
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.
RISK FACTORS
Although the exact cause of giant cell arteritis isn’t known, several factors can increase your risk, including:
Age. Giant cell arteritis affects older adults almost exclusively — the average age at onset of the disease is 70, and it rarely occurs in people younger than 50.
Sex. Women are about two times more likely to develop giant cell arteritis.
Northern European — especially Scandinavian — descent. Although giant cell arteritis can affect anyone, people born in Northern European countries appear to have higher rates of giant cell arteritis. People of Scandinavian origin are particularly at risk.
Polymyalgia rheumatica. People with polymyalgia rheumatica have stiffness and aching in the neck, shoulders and hips. About 15 percent of people with polymyalgia rheumatica also have giant cell arteritis.
COMPLICATIONS
Giant cell arteritis can cause the following complications:
Blindness. This is the most serious complication of giant cell arteritis. The swelling that occurs with giant cell arteritis narrows your blood vessels, reducing the amount of blood — and, therefore, oxygen and vital nutrients — that reaches your body’s tissues. Diminished blood flow to your eyes can cause sudden, painless vision loss in one or, in rare cases, both eyes. Unfortunately, blindness is usually permanent.
Aortic aneurysm. Having giant cell arteritis increases your risk of aneurysm. An aneurysm is a bulge that forms in a weakened blood vessel, usually in the aorta, the large artery that runs down the center of your chest and abdomen. An aortic aneurysm is a serious condition because it may burst, causing life-threatening internal bleeding. Because it may occur even years after the initial diagnosis of giant cell arteritis, your doctor may monitor the health of your aorta with annual chest X-rays or other imaging tests, such as ultrasound, CT scan or MRI.
Stroke. In some cases, a blood clot may form in an affected artery, obstructing blood flow completely, depriving part of your brain of necessary oxygen and nutrients, and causing stroke. This serious condition is an uncommon complication of giant cell arteritis.
PREPARING FOR YOUR APPOINTMENT
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
Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance. For some tests involved in diagnosing giant cell arteritis, you may need to follow special instructions before the appointment.
Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information, including any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements that you’re taking, along with the dosage information.
Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.
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:
What’s the most likely cause of my symptoms?
Are there any other possible causes?
What kinds of tests will I need to confirm the diagnosis? Do these tests require any special preparation?
What are my treatment options?
What types of side effects can I expect from the medication?
How long do I need to stay on medication, and what’s my long-term prognosis?
Will giant cell arteritis come back?
I have these other health conditions. How can I best manage these conditions together?
Do I need to change my diet in any way? Do I need to take any supplements?
Are there any brochures or other printed material that I can take with me? What websites do you recommend?
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:
When did you first begin experiencing symptoms?
Have your symptoms been continuous or occasional?
How severe are your 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 taking a pain reliever such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) might help ease head pain or tenderness.
TESTS AND DIAGNOSIS
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:
Physical exam. In addition to asking about your symptoms and medical history, your doctor is likely to perform a thorough physical exam, paying particular attention to your temporal arteries. Often, one or both of these arteries are tender with a reduced pulse and a hard, cord-like feel and appearance.
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:
Magnetic resonance angiography (MRA). This test combines the use of magnetic resonance imaging (MRI) with the use of a contrast material that produces detailed images of your blood vessels. Let your doctor know ahead of time if you’re uncomfortable being confined in a small space because the test is conducted in a tube-shaped machine.
Doppler ultrasound. This test uses sound waves to produce images of blood flowing through your blood vessels.
Positron emission tomography (PET). Using an intravenous tracer solution that contains a tiny amount of radioactive material, a PET scan can produce detailed images of your blood vessels and highlight areas of inflammation.
TREATMENTS AND DRUGS
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:
Osteoporosis
High blood pressure
Muscle weakness
Glaucoma
Cataracts
Other possible side effects of corticosteroid therapy include:
Weight gain
Increased blood sugar levels, sometimes leading to diabetes
Thinning skin and increased bruising
Weakened immune system, leading to susceptibility to infection and delayed healing
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.
LIFESTYLE AND HOME REMEDIES
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:
Eat a healthy diet. Eating well can help prevent potential problems, such as thinning bones, high blood pressure and diabetes. Emphasize fresh fruits and vegetables, whole grains, and lean meats and fish, while limiting salt, sugar and alcohol. Be sure to get adequate amounts of calcium and vitamin D. Experts recommend between 1,000 and 1,200 milligrams of calcium and 800 international units (IU) of vitamin D a day. 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 also benefits your heart and lungs. In addition, many people find that exercise improves their mood and overall sense of well-being. If you’re not used to exercising, start out slowly and build up gradually, aiming for at least 30 minutes on most days. Your doctor can help you plan an exercise program that’s right for you.
COPING AND SUPPORT
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.