 scalp
- swollen, bumpy, tender arteries in the temple, often lacking a noticeable pulse
- weak or painful jaw muscles - lack of oxygen to jaw muscles causes chewing brings on pain that goes away when stopped
- weight loss
- anemia and other blood abnormalities
If arteritis is left untreated, it can progress to the following symptoms:
- blind spots or sudden blindness in one eye
- heart attack
- other serious conditions due to impaired blood flow in the arteries
Blindness is a serious threat in arteritis. In a few cases, vision loss is the first sign of GCA. Unfortunately, any damage already done is usually irreversible. Most people get warning symptoms (called prodromes), such as fluctuating vision, black curtains that briefly descend over vision in one eye (called amaurosis fugax), and headaches, giving them time to take action and see their doctor.
At least 50 % of GCA patients also have polymyalgia rheumatica (PMR). About 10% to 20% of people with PMR go on to develop GCA. Arteritis may appear before, during, or after the onset of PMR. The primary symptoms of PMR are severe stiffness and pain in the neck, shoulder, and hip muscles. There may also be fatigue, joint pain, and anemia.
Making the Diagnosis
GCA is diagnosed by a thorough physical examination, blood tests, and sometimes by taking a biopsy (tissue sample) of the affected temporal arteries. Two tests, the erythrocyte sedimentation rate (ESR) and C-reactive protein, are usually elevated in GCA. The ESR measures how fast erythrocytes (red blood cells) settle to the bottom of a thin test tube.
It may be necessary to do tests that take images of the blood vessels in the chest and neck and to check for signs of heart damage. GCA can damage the aorta (the largest artery in the body, which originates in the heart) and other major vessels. Tests such as ultrasound, MRA and PET scans of the temporal artery can take images in a non-invasive manner . Sometimes, an angiogram needs to be done.
If a biopsy is needed, usually a couple of centimetres are removed from the temporal artery, sometimes from both sides of the forehead. Taking two samples can give a more reliable diagnosis.
Note that arteritis is an inflammation of the arteries that comes on over a fairly short period of time, which is different from atherosclerosis, which is hardening of the arteries that occurs gradually.
Treatment and Prevention
Giant cell arteritis (GCA) is treatable, and complications can be avoided when treatment is started early enough. As blindness and other severe consequences can come on suddenly, doctors will start treatment as soon as the disease is suspected; confirmation of diagnosis can be done after starting treatment.
The medication usually used is prednisone*, a corticosteroid that reduces inflammation. Treatment begins with a high dose to bring down the inflammation in the arteries under control. This is then slowly tapered to a lower dose that is called the "maintenance dose," as recommended by the doctor. Long-term use of corticosteroids poses a risk of serious side effects, and maintaining the lowest dose possible helps reduce those risks.
Some people need to keep taking low doses for a year or two before their doctor can be sure that symptoms won't return. Others may need to take prednisone for 5 to 10 years or indefinitely. Sometimes, symptoms recur a few times early in treatment and the dosage has to be temporarily raised. GCA usually does not recur after treatment is finally stopped, but a person with aortic disease needs to be monitored regularly by their doctor once it occurs.
The following side effects are associated with corticosteroid use, but they are much less likely with the lower doses given for GCA after gradually tapering from the initial high dose to a lower dose:
- degeneration of hip or shoulder bones
- easy bruising
- fluid retention and weight gain
- higher blood pressure
- increased susceptibility to infections, including serious infections
- osteoporosis (your doctor may recommend taking calcium and vitamin D supplements to help prevent osteoporosis)
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