Giant Cell Arteritis
What is Giant Cell Arteritis?
Giant cell arteritis is a vascular condition characterized by swelling which occurs in the inner linings of the arteries resulting pain. Generally, it occurs in large and medium sized arteries and is most often observed in the head region especially in temporal area (temples). Hence, it is also called temporal arteritis.
What Causes Giant Cell Arteritis?
There are no known specific causative factors for the condition. However, an active immune response to some triggering agent may cause inflammation in the artery walls. This leads to narrowing of space inside the artery and reduced blood flow which interrupts the nutrients and oxygen supply to the target tissues.
The possible risk factors include:
- Age, being above 50 years old
- Polymyalgia rheumatica(PMR)
- Sex, being female
- Race, being Caucasian
- Family history or genetic predisposition
- Auto-immune conditions
- Varicella zoster viral(VZV) infection
What are the Symptoms of Giant Cell Arteritis?
You may experience the following symptoms such as:
- Intermittent or persistent pain in the head and scalp, especially over the temples
- Jaw pain while chewing or opening mouth wide and talking
- Fever
- Visual disturbances
- Fatigue
- Stiffness in the neck and shoulder
- Acute tinnitus (ringing sensation in the ear)
- Weight loss
How is Giant Cell Arteritis diagnosed?
Your doctor does a thorough physical examination and notes past medical history. The following tests might be ordered to confirm the condition:
Blood Tests: These are done to rule out inflammatory markers.
- Erythrocyte Sedimentation Rate(ESR)
- C-reactive protein(CRP)
Imaging tests: They are done to identify abnormal changes in the soft tissues.
Ultrasound
- Magnetic Resonance Arteriogram(MRA)
- Positron Emission Tomography(PET)
Biopsy: A small sample of the artery is taken under local anesthesia and examined under a microscope in laboratory. If the study result shows abnormally enlarged cells due to inflammation, it confirms the condition.
What are the Complications of Giant Cell Arteritis?
- Loss of vision or blindness: Inflammation reduces blood flow to the ophthalmic arteries that supply blood to the eyes and surrounding tissues resulting in vision impairments or permanent blindness.
- Stroke: The narrowing of the arteries due to inflammation can cause blood clots leading ischemic stroke.
- Aortic Aneurysm: Inflammation weakens the artery and can cause localized bulging which is known as an aneurysm. If this occurs in the aorta, which is the largest artery in the human body, there is a risk of that the aneurysm might burst, causing a life-threatening condition.
How is Giant Cell Arteritis Treated?
The main line of treatment for Giant Cell Arteritis is conservative management which includes:
- Corticosteroids and anti-inflammatory drugs: These medicines are given in high doses for a long period and gradually tapered down.
- Anti-rheumatic drugs: These medicines are used if the condition is associated with polymyalgia rheumatica (PMR) or auto-immune conditions.
- Biological therapies: These are newly approved drugs from the FDA, which targets key cells within the immune system to stop inflammatory activities.
- Analgesics (pain relievers): These can be taken for pain management.
Adverse Effects of Steroid Treatment for Giant Cell Arteritis
For treatment of giant cell arteritis corticosteroids are used in high doses to prevent the risk of vision loss and other complications. However, steroids used for a long time can affect the body’s immune response and cause severe side effects as well, such as:
- Osteoporosis
- Risk of fractures due to weaken bones
- Muscle weakness
- Fluid retention
- Cataract
- Glaucoma
- Diabetes
- Hypertension
- Weight gain
- Sleep disturbances
- Psychological disorders
Prevention of Side Effects from Steroid Treatment for Giant Cell Arteritis
The preventive measures that can be followed to manage the complications and side effects of long term steroid use include:
- Taking calcium and vitamin D supplements to avoid bone thinning
- Going for regular health checkups
- Monitoring your blood glucose and blood pressure regularly
- Visiting your rheumatologist in regular intervals
- Eating a nutrient-rich diet
