Giant Cell Arteritis: Epidemiology, Causes, Risk Factors, Signs,Symptoms, Treatment, Diagnosis, Prevention
Giant cell arteritis is also known as temporal arteritis or cranial arteritis.
The arteries are flexible tubes that consist of thick elastic walls. After leaving the heart, the oxygenated blood passes through the aorta i.e. the main artery of the body. The aorta is the artery which consists of small divisions of arteries that usually help in carrying the blood to each part of the body along with internal organs and brain.
Giant cell arteritis is a condition in which lining of few of these subdivided arteries becomes inflamed resulting in swelling and reduced blood flow. The exact reason for inflammation of these arteries in giant cell arteritis is unknown, however giant cell arteritis usually affects any of the medium and large sized arteries.
The arteries in the head, specifically in the temples, are usually affected with giant cell arteritis due to which sometimes it is also known as cranial arteritis and temporal arteritis.
Giant cell arteritis often results in jaw pain, double or blurred vision, and headaches. The most serious complications of giant cell arteritis are blindness and stroke, however, stroke is less frequent condition in giant cell arteritis.
Timely treatment of giant cell arteritis is crucial for prevention of permanent loss of vision and tissue damage. A corticosteroid medication not only helps in relieving the symptoms of giant cell arteritis but also prevents loss of vision.
Epidemiology of Giant Cell Arteritis
The giant cell arteritis progressively increases after 50 years of age. Giant cell arteritis is very common in Northern European countries. Women are three times more prone to giant cell arteritis when compared to men. About half the individuals suffering with giant cell arteritis also have polymyalgia rheumatica.
Causes and Risk Factors of Giant Cell Arteritis
Although the exact cause of giant cell arteritis is unknown, factors that usually contribute in increasing the risk for developing the condition may include:
- Age: Giant cell arteritis usually affects older adults such as in 70 years of age. Giant cell arteritis is very rare in individuals younger than 50 years of age.
- Sex: Women are two times more prone to giant cell arteritis when compared to men.
- Northern European (Especially Scandinavian Descent): Giant cell arteritis is very common among people in Northern European countries. Individuals of Scandinavian origin specifically get affected with giant cell arteritis.
- Polymyalgia Rheumatica: Patients suffering with polymyalgia rheumatica have aching and stiffness in the shoulders, hips and neck. Approximately 15 percent of individuals suffering with polymyalgia rheumatica also suffer with giant cell arteritis.
Signs and Symptoms of Giant Cell Arteritis
In some individuals the beginning of the giant cell arteritis may appear as flu like symptoms accompanied with muscle aches and stiffness around the hips and shoulders, fatigue and fever and headaches. However, symptoms of giant cell arteritis may include:
- Constant severe head pain and tenderness specifically in temple region.
- General ill feeling.
- Jaw pain is also experienced while chewing and opening wide mouth.
- Excessive sweating.
- Stiffness and pain in the neck.
- Pain and stiffness in upper arms.
- Pain and stiffness in the shoulders.
- Pain and stiffness in the hips.
- Throbbing headache on either side of the head and at the back of the head.
- Weight loss.
- Loss of appetite.
- Muscle aches.
- Excessive tiredness.
- Double vision.
- Reduced vision resulting in blindness in either or both the eyes.
- Blurred vision.
- Scalp sensitivity, feeling tenderness on touching the scalp.
Other Symptoms Of Giant Cell Arteritis May Include:
- Hearing loss.
- Joint stiffness.
- Joint pain.
- Mouth sores.
- Bleeding gums.
- Face pain.
Approximately 40 percent of individuals may experience other, nonspecific symptoms like respiratory problems (most often dry cough) or pain or weakness along several nerve regions. Paralysis of eye muscles is a rare occurrence.
Treatment for Giant Cell Arteritis
- Treatment of giant cell arteritis primarily concentrates on reducing tissue damage that occurs due to deficient blood flow.
- Oral corticosteroids are the first line of drugs used to treat giant cell arteritis. Aspirin may also be prescribed.
- Medications need to be continued for one to two years although patients may start to recover within few days. Corticosteroids dose needs to be reduced gradually over a period of time.
- Immunosuppressants are also required in some cases.
Using corticosteroid medications for prolonged period not only result in thinning of bones, but also increase the possibility of fracture. Safety measures for preventing these may include:
- Quitting smoking.
- Avoiding excess alcohol intake.
- Taking vitamin D and extra calcium.
- Weight-bearing exercises.
- Periodic bone density test or DEXA scan to monitor the bones.
Diagnosis of Giant Cell Arteritis
A complete subjective and physical examination is performed to diagnose giant cell arteritis. Signs like tenderness and sensitivity of the scalp along with thickening of artery on either side or weak pulse or no pulse of affected artery may implicate giant cell arteritis.
In most of the cases, biopsy and examination of tissue of the affected artery verify the diagnosis of giant cell arteritis. Biopsy is carried out on an outpatient basis when the patient is under local anesthesia.
Other Tests To Diagnose Giant Cell Arteritis May Include:
- Liver function tests.
- Sedimentation rate and C-reactive protein.
- Hemoglobin or hematocrit.
- PET scan.
- Duplex ultrasound.
Prevention of Giant Cell Arteritis
Prompt treatment is essential to prevent permanent vision loss and damage to other tissues. The increasing age, the condition and the treatment can increase the risk of certain conditions like muscle weakness, osteoporosis, blood pressure, weakened immune system.
It is advisable to consult the physician and plan a treatment regimen to counter the possible side effects of steroid treatment. Monitoring bone density, taking vitamins, calcium and vitamin D supplements may be considered.
In addition to these, it is worth following a healthy lifestyle, which includes a healthy balanced diet to provide adequate nutrition, plenty of fresh fruits and vegetables, fibrous food, fish and adequate intake of water. It is good to avoid alcohol or smoking and limit the intake of salt and sugar. Maintain ideal weight as far as possible and exercise regularly to preserve health. Walking for at least 20 to 30 minutes is the safest way that offers a host of health benefits.