A patient in her 80s visited our General Internal Medicine Clinic to be evaluated with symptoms of a new throbbing headache involving her temples. She was also experiencing malaise, dizziness, photophobia (sensitivity to light), and allodynia (sensitivity to touch) for about a week.
Her symptoms could have been attributed to many conditions, from migraines to a brain tumor. But early test results – including an elevated erythrocyte sedimentation rate (ESR) – indicated that giant cell arteritis could be the culprit.
Giant cell arteritis (GCA) is a type of vasculitis, or inflammation of the blood vessels, usually affecting the arteries that supply blood to the head and scalp, including the area over the temples, which is why it’s sometimes called temporal arteritis. The term “giant cell arteritis” comes from what you’d see when looking at inflamed temporal arteries under a microscope: large or giant cells.
We promptly started our patient on a high dose of prednisone – a steroid medication – because of the risk for permanent vision loss if GCA is left untreated. Our next step was to schedule our patient for a temporal artery biopsy, which ultimately confirmed the diagnosis. After GCA is diagnosed, patients need close follow-up by a Neuro-Ophthalmology specialist with periodic lab monitoring and medication adjustments.
Recognizing and diagnosing GCA can be challenging, especially as its early symptoms can mimic those of a migraine. At UT Southwestern, we are experts at spotting the clues that can lead to early diagnosis and treatment of this complex disorder.
Along with avoiding serious complications, prompt treatment of giant cell arteritis usually relieves symptoms quickly and can help prevent a relapse.
GCA is a rare condition that can go unrecognized or be mistaken for another condition. However, UT Southwestern internal medicine experts are specially trained to dig deeper if symptoms don’t match the most apparent diagnosis.
Causes, complications, and risk factors
When arteries become inflamed, they swell and narrow, reducing the amount of blood that reaches your body’s tissues. If blood flow to the eyes is diminished, it can cause sudden vision loss in one or both eyes. While less common, reduced blood flow due to GCA also can lead to a stroke.
Giant cell arteritis affects approximately 10 per 100,000 people age 50 or older. There is no known cause for GCA, but there are several factors that can increase your risk of getting it, including:
- Age: GCA only affects adults, usually after age 50.
- Sex: Women are twice as likely to develop as men.
- Family history: GCA tends to run in families.
- Race and ethnicity: It is most common among white people of Northern European descent.
People who have polymyalgia rheumatica (PMR) also are at increased risk of developing giant cell arteritis. PMR is an inflammatory disorder that causes muscle pain and stiffness around the shoulders and hips. It is possible to have PMR and GCA at the same time.
Symptoms of giant cell arteritis
Early symptoms of GCA can be nonspecific and resemble those of influenza, such as fever and fatigue. The most common symptom of GCA is a headache, which can occur anywhere but usually is focused over the temples. The headache may get progressively worse or come and go.
Other symptoms may include:
- Pain or tenderness over the scalp, particularly over the temples
- Double vision or vision loss
- Dizziness or problems with balance and coordination
- Jaw pain when chewing
If you develop a new, persistent headache or any other of the above symptoms, see your doctor right away. It’s better to be safe and prevent serious complications such as vision loss or stroke.
How we diagnose giant cell arteritis
There is no one simple test to confirm giant cell arteritis. According to the American College of Rheumatology, three of the following five criteria need to be present for a GCA diagnosis:
- Age 50 or older
- New, localized headache
- Temporal artery tenderness
- Elevated erythrocyte sedimentation rate (ESR), a blood test that can reveal inflammatory activity in the body
- Positive temporal artery biopsy
A temporal artery biopsy is an outpatient procedure done under local anesthesia. This procedure involves removal of a small section of the temporal artery to be examined under a microscope for signs of inflammation.
How we treat giant cell arteritis
The main treatment for giant cell arteritis consists of high doses of corticosteroids, such as Prednisone, which reduces inflammation. After a month, we’ll begin to lower the dosage over the next months or year. The speed at which we lower the dose will depend on whether you have recurring symptoms or there are increases in your ESR. Patients are usually tapered off corticosteroids after one year.
Long-term corticosteroid use can lead to side effects such as osteoporosis, high blood sugar and high blood pressure. We’ll monitor your blood sugar, blood pressure and bone density while you are being treated with corticosteroids. and may prescribe calcium, vitamin D supplements, or other medications to prevent such complications. GCA rarely returns after treatment.
The importance of multidisciplinary care
Early diagnosis of GCA is the key to preventing long-term damage. At UT Southwestern, our team of specialists, internists, and nurse practitioners will listen to you and dig deeper to find what might be causing your symptoms. Our team is well-versed in the latest research and treatments.
If you need a specialist, we are fortunate to work with some of the best. In the case of giant cell arteritis, you might be referred to a Neuro-Ophthalmologist, a Rheumatologist, an Otolaryngologist, or a Neurologist, depending on your symptoms. You know your body best. If something doesn’t feel right, see your doctor right away.