Giant Cell Arteritis

Conditions Basics

What is giant cell arteritis?

Giant cell arteritis (say "ar-tuh-RY-tus"), or GCA, is inflammation of the blood vessels. It mostly affects the arteries that carry blood to the head, especially those that supply the eyes, temple, and jaw. Because it often affects the artery in the temple, it is also called temporal arteritis.

People who have GCA need to be treated right away. That's because it can cause loss of vision.

Some people who have GCA also have polymyalgia rheumatica. This is another inflammatory condition that affects the muscles. It causes pain and stiffness in the neck, shoulder, and hip area. The same medicines are used to treat both conditions.

What causes it?

Experts don't fully understand what causes it. It may be that the immune system is attacking the body's own tissues. Your genes may play a role in this. For example, people whose ancestors are from Scandinavia or Northern Europe are more likely to have this problem.

GCA occurs in women more often than men. It is more common as people get older.

What are the symptoms?

Symptoms may start either suddenly or slowly. They may include:

• A new headache, often near the temple or around the eye. This is the most common symptom.
• Pain in the jaw, especially when you chew.
• Vision problems such as double vision or brief loss of vision.
• Tenderness on the side of the head or scalp. The blood vessel on the temple may look swollen. And it may hurt to wear glasses or comb your hair.

How is it diagnosed?

Your doctor will do a physical exam and ask you about your symptoms and past health. For example, the doctor may look for arteries on the temple or forehead that are swollen, lumpy, or tender. This is a sign of GCA.

The doctor will also consider your age in diagnosing this condition. People younger than 50 very rarely have GCA.

The doctor may order tests too. These may include:

• Temporal artery biopsy. For this test, a surgeon takes a small tissue sample from a blood vessel in your temple and checks it for inflammation.
• Complete blood count. This test can show if you have anemia, which is common in people who have giant cell arteritis.
• Blood tests such as sedimentation rate and C-reactive protein. These tests can show if you have inflammation in your body.

Some other conditions can cause similar symptoms. Your doctor may also do tests to rule out those conditions, which include arthritis and hypothyroidism.

How is giant cell arteritis treated?

Giant cell arteritis is treated with steroid medicines, which reduce inflammation. GCA is dangerous because it can cause serious problems, such as blindness. So your doctor may start you on the medicine right away, even before the diagnosis is confirmed.

You'll probably feel better in a day or two after you start the medicine. Most of the time, symptoms improve quickly and go away 2 to 4 weeks after treatment starts. But if you have vision loss, you may be given the steroids through a vein (I.V.) in your arm at first. After that, you will take the medicine by mouth. You may need to take the medicine for a long time to keep your symptoms from coming back.

Long-term treatment with steroid medicine will put you at risk for problems such as bone thinning (osteoporosis). Your doctor may recommend taking calcium and Vitamin D. Calcium can help prevent bone thinning. Vitamin D helps your body absorb the calcium. Because of the risks of long-term treatment with steroids, talk to your doctor about all of your options.

Your doctor may also suggest that you take aspirin. Some studies show that taking aspirin may reduce the risk of vision loss and stroke.

In some people, symptoms improve with treatment but then come back. This is called a relapse. It often occurs in the first 2 years of treatment or during the first year after steroid medicine is stopped. Your doctor will track your condition during this time. If you have a relapse, your doctor will increase the steroid dosage for a while. Then you can slowly lower it after your symptoms go away.

Your doctor may prescribe another medicine, such as methotrexate or tocilizumab, if you continue to have symptoms after your steroid dose is lowered. This is sometimes called steroid-sparing treatment.

In rare cases, giant cell arteritis may affect a part of the aorta, a large blood vessel in the chest. This can cause an aortic aneurysm, which can be life-threatening. Your doctor may want you to follow up each year to watch for this problem.

How can you care for yourself during treatment?

When you are being treated with steroids:

• Make sure you get all recommended vaccines. Taking steroids can weaken your immune system, and vaccines can help protect you from getting sick.
• Get regular weight-bearing exercise, such as walking, dancing, or weight lifting. This will help keep your bones strong and may also help your mood.
• Don't smoke, and avoid being around tobacco smoke.
• Limit alcohol. It's a good idea to have no more than one beer or one glass of wine each day.
• Be sure you get enough calcium and vitamin D. Calcium can help prevent bone thinning. Vitamin D helps your body absorb calcium.
• Take your medicines exactly as prescribed. Call your doctor if you have any problems with your medicine.