Giant Cell Arteritis (GCA) is a serious inflammatory condition that affects the large arteries, particularly those in the head. Often associated with temporal arteritis, it is the most common form of vasculitis (inflammation of the blood vessels) in older adults. The condition is marked by inflammation of the lining of the arteries, particularly the temporal arteries, which run along the sides of the head. This can lead to a variety of symptoms and, if left untreated, severe complications such as vision loss.

 

This blog provides an in-depth understanding of giant cell arteritis, including its causes, symptoms, diagnosis, treatment, and prognosis.

 

What is Giant Cell Arteritis?

 

Giant cell arteritis is a type of vasculitis, a condition that causes inflammation of the blood vessels. In GCA, the inflammation occurs primarily in the arteries of the head and neck, particularly the temporal arteries. It can also affect other large arteries, such as the aorta and its branches. The condition is named after the giant cells that are often found in the walls of the inflamed arteries when viewed under a microscope.

 

GCA is a systemic disorder, meaning it can affect the whole body. While it predominantly impacts the arteries of the head, it can also involve other arteries, leading to symptoms in other parts of the body. The condition primarily affects older adults, typically those over the age of 50, and is more common in women than in men.

 

Giant Cell Arteritis

 

Causes of Giant Cell Arteritis:

The exact cause of giant cell arteritis is unknown, but it is believed to be the result of an abnormal immune system response. In GCA, the immune system mistakenly attacks the walls of the arteries, leading to inflammation. Factors that may contribute to the development of GCA include:

 

  1. Age: GCA almost exclusively affects people over the age of 50, with the average age of onset being around 70.
  2. Gender: Women are two to three times more likely to develop GCA than men.
  3. Genetics: There is evidence that a genetic predisposition plays a role in the development of GCA. Certain genetic markers, such as HLA-DRB1 alleles, have been associated with an increased risk of the condition.
  4. Environmental factors: Some research suggests that environmental triggers, such as infections, may play a role in the development of GCA. However, no specific infection has been conclusively linked to the condition.

 

Giant Cell Arteritis symptoms:

GCA can present with a wide range of symptoms, and the onset can be either sudden or gradual. The most common symptoms include:

 

  1. Headache: A new, persistent headache is the most common symptom of GCA. The headache is usually located on one or both sides of the head, often in the temples, and may be severe.
  2. Tenderness in the scalp or temples: The scalp may become tender to the touch, particularly in the area of the temporal arteries. This tenderness can make simple activities, like combing the hair, uncomfortable.
  3. Jaw claudication: This refers to pain or fatigue in the jaw muscles that occurs during chewing or speaking and resolves with rest. It is a classic symptom of GCA.
  4. Vision problems: Blurred vision, double vision, or sudden, partial, or complete loss of vision in one or both eyes can occur. If untreated, GCA can lead to permanent vision loss due to damage to the arteries supplying the optic nerve.
  5. Fatigue and malaise: Many people with GCA experience a general feeling of being unwell, along with fatigue, fever, and weight loss.
  6. Polymyalgia rheumatica (PMR): About 40-50% of people with GCA also have PMR, an inflammatory condition that causes pain and stiffness in the shoulders, hips, and neck.
  7. Muscle aches and joint pain: GCA can cause aching and stiffness, particularly in the shoulders, neck, and hips, often making movement difficult.
  8. Fever: Low-grade fevers are common in GCA, and some individuals may experience flu-like symptoms.
  9. Aortic involvement: In some cases, GCA can involve the aorta and its branches, leading to symptoms such as arm pain, dizziness, or even aneurysm formation.

 

Complications of Giant Cell Arteritis:

GCA is a serious condition that can lead to significant complications if not treated promptly. Some of the most concerning complications include:

 

  1. Vision loss: One of the most feared complications of GCA is permanent vision loss, which occurs in up to 15-20% of untreated cases. This happens when the arteries supplying the optic nerve become blocked due to inflammation, leading to ischemia (lack of blood flow) and subsequent damage to the nerve.
  2. Stroke: GCA can cause narrowing or blockage of the arteries that supply the brain, increasing the risk of stroke.
  3. Aortic aneurysm: GCA can cause inflammation in the aorta, the body’s largest artery. Over time, this can lead to the formation of an aneurysm, which is a bulge in the artery wall. Aortic aneurysms can rupture, causing life-threatening internal bleeding.
  4. Aortic dissection: In rare cases, GCA can lead to aortic dissection, a condition in which the layers of the aortic wall tear apart, potentially leading to death.

 

Diagnosis of Giant Cell Arteritis:

Diagnosing GCA can be challenging because its symptoms overlap with those of other conditions, and the presentation can be highly variable. A combination of clinical evaluation, laboratory tests, and imaging studies is typically used to confirm the diagnosis.

 

  1. Physical examination: The doctor will check for signs of inflammation, such as tenderness over the temporal arteries, diminished or absent pulses, and scalp tenderness. A thorough history of symptoms is also important.
  2. Blood tests: Certain blood tests can help support the diagnosis of GCA, including:
    • Erythrocyte sedimentation rate (ESR): This test measures how quickly red blood cells settle at the bottom of a test tube. An elevated ESR indicates inflammation.
    • C-reactive protein (CRP): This is another marker of inflammation that is often elevated in GCA.
    • Complete blood count (CBC): Many people with GCA have mild anemia and an elevated platelet count.
  3. Temporal artery biopsy: The gold standard for diagnosing GCA is a biopsy of the temporal artery. During this procedure, a small section of the artery is removed and examined under a microscope for signs of inflammation and the presence of giant cells. While a positive biopsy confirms the diagnosis, a negative biopsy does not rule out GCA, as the inflammation can be patchy.
  4. Imaging studies: In some cases, imaging studies may be used to assess the extent of the disease and to detect involvement of the aorta and its branches. These studies may include:
    • Ultrasound: Doppler ultrasound can help identify inflammation in the temporal arteries and other large arteries.
    • Magnetic resonance angiography (MRA): This imaging test can provide detailed images of the arteries and help identify areas of inflammation or narrowing.
    • Positron emission tomography (PET) scan: This can be used to detect inflammation in large arteries, particularly in the aorta.

 

Treatment of Giant Cell Arteritis:

GCA is a medical emergency that requires prompt treatment to prevent complications such as vision loss. The mainstay of treatment is corticosteroids, which reduce inflammation and prevent damage to the arteries.

 

  1. Corticosteroids: High-dose corticosteroids, such as prednisone, are typically started as soon as GCA is suspected, often before a definitive diagnosis is made. The dose is usually tapered over several months to years, depending on the response to treatment and the risk of relapse.
  2. Steroid-sparing agents: Long-term use of corticosteroids can lead to side effects such as osteoporosis, high blood pressure, and diabetes. To minimize these risks, doctors may prescribe medications that allow for a lower dose of steroids. These include methotrexate and tocilizumab, a biologic drug that blocks the action of a specific immune system protein involved in inflammation.
  3. Aspirin: Low-dose aspirin may be prescribed to reduce the risk of blood clots and stroke.
  4. Monitoring and prevention of complications: Regular monitoring is necessary to check for side effects of corticosteroids and for any signs of complications such as vision loss or aortic involvement. Bone health should also be monitored, and calcium and vitamin D supplements may be recommended to prevent osteoporosis.

 

Prognosis of Giant Cell Arteritis:

With prompt treatment, the prognosis for GCA is generally good. Most people respond well to corticosteroids and experience a significant improvement in symptoms within days to weeks. However, GCA is a chronic condition, and relapse is common, particularly during the tapering of corticosteroids. Close follow-up with a healthcare provider is essential to monitor for relapses and to adjust treatment as needed.

 

Long-term use of corticosteroids can lead to side effects, so minimizing steroid exposure while controlling the disease is a key goal of treatment. In some cases, GCA may affect other large arteries, leading to complications such as aneurysms or aortic dissection, so ongoing monitoring is necessary.

 

Giant cell arteritis is a serious, potentially life-threatening condition that requires prompt diagnosis and treatment to prevent complications such as vision loss and stroke. Although the exact cause of GCA is not fully understood, it is thought to be related to an abnormal immune response. Treatment with corticosteroids is highly effective, but long-term monitoring is essential to prevent relapse and manage potential side effects.

 

Understanding the symptoms, risks, and treatment options for GCA is crucial for early detection and improving outcomes in affected individuals. With appropriate care, most people with GCA can lead a healthy, normal life.

 

To consult a Doctor at Sparsh Diagnostic Centre, call our helpline number 9830117733.

 

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Disclaimer:

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

 

 

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