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Giant cell arteritis, also referred to as temporal arteritis or Horton’s arteritis, is a blood vessel inflammation. The temporal arteries, or the blood vessels next to the temples, are most frequently affected. The vasculitis which causes temporal arteritis can extend its effects beyond the temporal arteries. It has the potential to involve other blood vessels, including the posterior ciliary arteries, which can result in vision loss. Additionally, this condition can affect larger blood vessels such as the aorta and its branches, leading to significant health complications.
Giant cell arteritis commonly results in headaches, tenderness in the scalp, jaw pain, and problems with vision. Temporal arteritis can lead to the sudden blindness of one or both eyes, aneurysm, or other complications such as stroke or transient ischemic attacks if it is not identified and treated right away.
Giant cell arteritis symptoms are typically relieved by immediate corticosteroid treatment, which may also prevent vision damage. After a few days of treatment, the patient should start to feel better. Relapses are common even after receiving treatment.
To monitor for any side effects from taking corticosteroids, it is recommended to have regular visit with the healthcare provider.
Symptoms
The predominant symptoms of giant cell arteritis often include intense headaches and tenderness, typically affecting both temples. The headaches may progressively worsen, temporarily alleviate, or have an intermittent pattern.
Typically, giant cell arteritis signs and symptoms include:
- Scalp or temples tenderness
- Jaw pain when opening the mouth or chewing
- Fever
- Fatigue
- Loss of appetite
- Unintentional weight loss
- Vision problems such as double vision, blurry vision, or transitory (brief) vision loss, may lead to permanent, irreversible vision loss if they are not treated.
A related condition called polymyalgia rheumatica frequently manifests as neck, shoulder, or hip pain and stiffness. Polymyalgia rheumatica affects around 50% of those with giant cell arteritis.
If an individual encounters a new, persistent headache or any of the aforementioned symptoms, it is crucial to promptly seek medical attention. Once giant cell arteritis is diagnosed, initiating treatment without delay can generally help prevent visual impairment.
Causes
It is uncertain what causes these arteries to become inflamed, although it is assumed that the immune system is involved in abnormal attacks on the arterial walls. The vulnerability to the conditions may be increased by specific genes and environmental variables.
During giant cell arteritis, the lining of the arteries swells as a result of inflammation. As a result of the swelling, the blood vessels become more constricted and less blood, as well as oxygen and other essential nutrients, can reach the body’s tissues. A wide variety of large or medium-sized arteries might be affected, however inflammation most frequently affects the arteries in the temples. These start just above the ears and extend up into the scalp.
Risk factors
Giant cell arteritis risk can be affected by a number of factors, including:
- Age: People under 50 are rarely affected by giant cell arteritis. Between the ages of 70 and 80, the majority of those with this condition begin to exhibit signs and symptoms.
- Sex: Women are nearly twice as likely as men to have the condition.
- Family history. A medical condition can occasionally run in the family.
- Race: The majority of white patients with giant cell arteritis are of Scandinavian or Northern European heritage.
- Other medical condition: Patient is more likely to get giant cell arteritis if they have polymyalgia rheumatica.
Diagnosis
Because the initial symptoms of giant cell arteritis can mimic those of other common conditions, arriving at an accurate diagnosis can be challenging. To eliminate any additional potential causes of the problem, the healthcare provider will undertake the following measures.
- Physical examination: A complete physical examination, with special focus on the temporal arteries, is likely to be done by the healthcare provider. One or both of these arteries are frequently painful, have a weak pulse, and feel and seem rigid and cordlike.
- Blood test: The following tests may be carried out to assist in the diagnosis of the condition and to monitor treatment results.
- Erythrocyte sedimentation rate: This examination measures the rate at which red blood cells settle to the bottom of a blood tube. Often referred to as the sed rate. Rapid drop of red cell loss could be a sign of internal inflammation. The level of hemoglobin, which is the component of red blood cells that carries oxygen, will be measured in order to check for anemia.
- C-reactive protein (CRP): This gauges the substance that the liver makes when there is inflammation.
- Imaging tests: These could be used to identify giant cell arteritis and track the effectiveness of treatment. Tests could consist of:
- Doppler ultrasound: Images of blood moving through the blood vessels are created during this test using high-frequency sound waves.
- Magnetic resonance angiography (MRA): This procedure combines an MRI with a contrast agent to obtain detailed pictures of the blood arteries. The test is performed in a tube-shaped equipment, inform the healthcare provider know if being squeezed into a tight area makes it uncomfortable.
- Positron emission tomography (PET): The healthcare professional may suggest PET if they believe the patient has giant cell arteritis in significant arteries, such as the aorta. An intravenous tracer solution with a negligible amount of radioactive material is used in this test. The larger blood vessels can be seen in detail in a PET scan, which can also be used to identify areas of inflammation.
- Biopsy: A biopsy of the temporal artery is the most reliable test for giant cell arteritis diagnosis. This artery runs from a location near to the skin right in front of the ears up to the scalp. Local anesthetic is used during the outpatient operation, which typically results in minimal pain and scarring. In a laboratory, the sample is viewed through a microscope.
If the patient has giant cell arteritis, the artery will frequently exhibit inflammation that contains the giant cells. Giant cell arteritis can exist in the presence of a negative biopsy finding. The healthcare provider might suggest a second temporal artery biopsy on the opposing side of the head if the results are unclear.
Treatment
The main treatment for giant cell arteritis involves administering high doses of a corticosteroid medication such as prednisone. In order to prevent vision loss, healthcare providers will likely prescribe medication even prior to confirming the diagnosis through a biopsy, as timely therapy is crucial.
Within a few days of starting treatment, patient should start feeling better. If the patient had vision loss prior to beginning corticosteroid therapy, it is doubtful that the vision will become better. The unaffected eye, however, may be able to make up for some of the visual changes.
One to two years or longer may be required for the patient to continue taking their prescription. After the first month of treatment, healthcare provider may start to gradually reduce the dosage of corticosteroids until the patient has received the lowest amount of corticosteroids required to control inflammation.
During this tapering stage, some symptoms, particularly headaches, might return. At this point, many patients also start to experience polymyalgia rheumatica symptoms. Usually, mild dose increases of corticosteroids can control such flares. A healthcare provider may also advise using the immunosuppressant methotrexate.
Corticosteroids can lead to various serious adverse effects such as osteoporosis, high blood pressure, and muscle weakness. To mitigate these potential negative effects, a healthcare provider may assess bone density, suggest calcium and vitamin D supplements, or prescribe other medications to prevent bone loss.
