Arthritis: Giant Cell Arteritis

Giant Cell Arteritis is a disease of the small blood vessels and usually presents with swelling and thickening of the small arteries in and around the temples, called the temporal arteries. Patients often present with headaches in the temporal region.

Giant cell arteritis (GCA), also known as temporal arteritis, belongs to a family of arthritic diseases called vasculitis. Vasculitis means inflammation of blood vessels. GCA causes inflammation of the lining of the arteries, which leads to swelling inside the arteries.

Health experts don't understand the exact causes of giant cell arteritis. The most common arteries affected by GCA are around the head and neck, especially the area around the temples. This conditon can cut off the blood supply to your tissues and organs.

While giant cell arteritis can occur in people in their 50s or 60s, people aged 70 and older are most commonly affected by it. It's about twice as common in women than men, and people from Northern Europe have the highest rates of GCA. About half of the patients who have giant cell arteritis also have polymyalgia rheumatica.

If you have symptoms of giant cell arteritis, you'll probably be referred to a rheumatologist, who specializes in arthritis and autoimmune disease. In order to diagnose GCA, the rheumatologist will take your complete medical history,  perform a physical examination and order tests, which may include blood tests, scans and biopsies.

Symptoms of Giant Cell Arteritis

Pain or Tenderness in the Head and Temple

Most patients initially experience persistent pain or tenderness around one or both temples. GCA can make the area above the temporal artery (above the ear on the side of the head) very sensitive. As a result, you may find it's painful to lie on your pillow on that side. Other symptoms patients may experience include pain in the forehead, scalp, tongue and jaw while chewing. In rare cases of GCA, the temporal artery becomes very prominent.

Fatigue & Muscle Soreness

People with GCA may feel like they have the flu, experiencing fatigue, headache, fever and achy muscles. Seeing an athletic therapist, registered Dietician or family physician can help with additional treatment. 

Blindness

If giant cell arteritis becomes severe, the blood flow to areas supplied by the arteries can be cut off. This may lead to symptoms such as double vision, vision loss and eventually blindness.

Polymyalgia Rheumatica Symptoms

It is estimated that up to 70% of people with polymyalgia rheumatica also have giant cell arteritis. Symptoms of polymyalgia rheumatica include pain and stiffness in the neck, shoulders and hips, usually worse in the morning.

Common Tests for Polymyalgia Rheumatica

Biopsy of the Temporal Artery: This is considered the best test for diagnosing giant cell arteritis. During this minor operation, a the surgeon takes a biopsy of the temporal artery to be evaluated for inflammation of the artery wall.

Complete Blood Count (CBC), Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are commonly used to look for inflammation.

Ultrasound and/or Magnetic Resonance Imaging (MRI): Your rheumatologist may recommend imaging tests to look for inflammation in the artery walls.

Treatment for Giant Cell Arteritis 

When it comes to treating giant cell arteritis, the sooner the better. This disease must be treated very quickly and aggressively to help prevent serious consequences such as stroke and blindness. If a patient doesn't get effective treatment quickly, the inflammation can damage arteries that supply important organs and tissues in the body (e.g., eyes, brain).

GCA is most often treated with medications that work to control inflammation. In some patients, the disease goes into remission once inflammation is under control, and medication can be tapered off.

In other people, GCA is a chronic disease that requires small doses of medicine on a long-term basis.

Common medications for giant cell arteritis include:

Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Disease modifying anti-rheumatic drugs are typically used to treat patients with inflammatory arthritis. Methotrexate is a common example of a DMARD that has been effective in treating some patients with giant cell arteritis.

Taking methotrexate can also help reduce the dose of prednisone you need to keep inflammation under control, reducing the risk of side effects.

Corticosteroids 

Corticosteroid medications like prednisone can be very effective in controlling GCA symptoms and inflammation and preventing future damage.

For most patients, prednisone is prescribed at a high dose to bring inflammation under control. Once GCA symptoms have improved and markers of inflammation have come back to normal, your rheumatologist will taper the dose. That's because prednisone can have side effects such as osteoporosis when used long-term.

Biologics

This class of medications that target the immune system. Blocking a molecule called Interleukin-6 has been very effective in treating patients with giant cell arteritis. Actemra (tocilizumab) is a biologic that blocks Interleukin-6 and is approved for the treatment of GCA.

Talk to your rheumatologist if you'd like more information on osteoarthritis of the knee.  Seeing a registered dietician can help with diet and weight loss  and seeing a local kinesiologist could help with mobility and strength.

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