Giant cell arteritis - symptoms, diagnosis, treatment
Giant cell arteritis - symptoms, diagnosis, treatment
Giant cell arteritis is an inflammatory condition affecting arteries of the upper body and head. The most commonly affected are the temporal arteries on the side of the head and, for this reason, the condition can also be known as temporal arteritis or cranial arteritis.
Symptoms include headaches and blurred or double vision, as a result of inflammation thickening the lining of affected arteries to such a degree that blood flow is reduced or blocked. If left untreated there’s a risk of blindness and stroke as a result of impaired blood flow to the eyes and brain.
Giant cell arteritis affects approximately 20 out of every 100,000 people over the age of 50 years. The incidence of this condition increases with age. It is seldom seen in anyone under the age of 50 years and the average age of onset is 70 years.
The cause of giant cell arteritis is not fully understood. It is thought the inflammation may be due to an autoimmune reaction, where the body’s natural immune defenses mistakenly attack normal, healthy tissue.
Symptoms include headaches and blurred or double vision, as a result of inflammation thickening the lining of affected arteries to such a degree that blood flow is reduced or blocked. If left untreated there’s a risk of blindness and stroke as a result of impaired blood flow to the eyes and brain.
Giant cell arteritis affects approximately 20 out of every 100,000 people over the age of 50 years. The incidence of this condition increases with age. It is seldom seen in anyone under the age of 50 years and the average age of onset is 70 years.
The cause of giant cell arteritis is not fully understood. It is thought the inflammation may be due to an autoimmune reaction, where the body’s natural immune defenses mistakenly attack normal, healthy tissue.
Signs and symptoms
The condition usually begins with mild flu-like symptoms including mild fever and a persistent dull headache. Specific signs and symptoms will depend on which arteries are involved. These may include:
- Jaw pain - particularly when chewing
- Hearing problems
- Vision problems eg: blurred or double vision, loss of visual field
- Aching muscles about the neck and shoulders
- Loss of appetite
- Depression
Other symptoms can include tenderness of the scalp, cough, throat pain, tongue pain, and weight loss. There may also be visible swelling of the arteries on the side of the forehead. Symptoms may be vague at first, with a feeling of being generally unwell. Some patients have many symptoms; others have only a few. Symptoms tend to worsen as the condition progresses.
Giant cell arteritis is associated with a condition called polymyalgia rheumatica (PMR). PMR causes pain and stiffness in the muscles - particularly in the neck, shoulders and back. Approximately 15-25% of people with PMR also have giant cell arteritis.
Giant cell arteritis is associated with a condition called polymyalgia rheumatica (PMR). PMR causes pain and stiffness in the muscles - particularly in the neck, shoulders and back. Approximately 15-25% of people with PMR also have giant cell arteritis.
Diagnosis
Diagnosis is sometimes difficult because the symptoms of giant cell arteritis can mimic the symptoms of other conditions. In order to differentiate giant cell arteritis from other conditions it may be necessary to remove a small sample (biopsy) of the affected artery for testing. The characteristic changes in the tissue can indicate giant cell arteritis.
A blood test that determines the red blood cell sedimentation rate (erythrocyte sedimentation rate or ESR) may also be performed. A raised ESR indicates inflammation in the body and it may be considerably raised when giant cell arteritis is present. This test can also be performed to help monitor the progression of the disorder.
A blood test that determines the red blood cell sedimentation rate (erythrocyte sedimentation rate or ESR) may also be performed. A raised ESR indicates inflammation in the body and it may be considerably raised when giant cell arteritis is present. This test can also be performed to help monitor the progression of the disorder.
Treatment
Once a diagnosis of giant cell arteritis has been made, treatment is started as soon as possible in order to reduce the risk of complications. Corticosteroid medications – usually prednisone - are the main form of treatment. The dosage will depend on the nature and severity of symptoms experienced.
High doses of corticosteroid medications are usually required until symptoms improve. After this initial period, the dosage is usually gradually decreased to the lowest dose at which symptoms are controlled. Treatment continues until the condition has completely resolved – in some patients this is as long as two to five years. Sometimes a low dose treatment is required indefinitely.
Non-steroidal anti-inflammatory medications (NSAID's), such as voltaren, may also be given in order to relieve any pain associated with the condition.
The symptoms of giant cell arteritis recur in approximately 30% of cases. In these cases high dose corticosteroid treatment will be resumed and medications to suppress the immune system may be prescribed.
High doses of corticosteroid medications are usually required until symptoms improve. After this initial period, the dosage is usually gradually decreased to the lowest dose at which symptoms are controlled. Treatment continues until the condition has completely resolved – in some patients this is as long as two to five years. Sometimes a low dose treatment is required indefinitely.
Non-steroidal anti-inflammatory medications (NSAID's), such as voltaren, may also be given in order to relieve any pain associated with the condition.
The symptoms of giant cell arteritis recur in approximately 30% of cases. In these cases high dose corticosteroid treatment will be resumed and medications to suppress the immune system may be prescribed.
