Overview of Giant Cell Arteritis

Giant cell arteritis (also referred to as GCA, cranial arteritis, or temporal arteritis) is a type of vasculitis, a group of conditions with characteristic inflammation of the blood vessels. The vessels most commonly involved in giant cell arteritis are the arteries of the head and scalp, especially near the temples. There may be involvement of arteries of the neck and arms as well.

The most common symptom associated with giant cell arteritis is a new headache, typically near the temples, but it can occur anywhere over the skull. Generalized symptoms associated with giant cell arteritis include fatigue, loss of appetite, weight loss, flu-like sensations, and fevers that are prolonged or recurrent. Jaw pain or facial, tongue, or throat pain is possible but less common. It's also possible to experience dizziness or problems with balance.

Giant cell arteritis can affect the blood supply to the eye causing blurred vision, double vision, or blindness. If there is a loss of vision, it can occur suddenly and it may not be possible to reverse the vision loss. That's why it's imperative to seek medical treatment immediately when symptoms develop that may be related to giant cell arteritis. Early treatment may prevent permanent vision loss. People have a tendency to wait and see if symptoms subside. In the case of giant cell arteritis, that could prove to be a regrettable approach. 

There is no blood test that can definitively confirm the diagnosis of giant cell arteritis. The sedimentation rate is typically elevated with giant cell arteritis but its usefulness is limited since results are indicative of non-specific inflammation. To diagnose giant cell arteritis, a biopsy of a small piece of the temporal artery is required. The biopsied tissue is examined microscopically for inflammation.

Treatment for giant cell arteritis should begin as soon as possible -- as soon as it is suspected and even before there is confirmation from biopsy results. Typically, high doses of corticosteroids are prescribed (40 to 60 mg prednisone per day). While headaches and some other symptoms tend to resolve quickly with treatment, the high dose of corticosteroids is continued for a month and then decreased slowly to 5-10 mg per day for several more months, and stopped after 1 or 2 years. As the dose of corticosteroids is decreased, there is sometimes a return of symptoms that respond rapidly to an increased dose of corticosteroids. Once there is steroid-free remission, however, a recurrence of giant cell arteritis is considered unlikely and rare.

Giant cell arteritis affects older adults, usually over the age of 50. About 50% of patients with giant cell arteritis also have symptoms of polymyalgia rheumatica. Symptoms of both conditions, GCA and PMR, can occur simultaneously or separately. Females are more commonly affected by giant cell arteritis than men, and whites more than non-whites. It has been estimated that 200 per 100,000 people over 50 years old develop giant cell arteritis.