Giant Cell Arteritis
Giant cell arteritis (GCA) is the inflammation of an artery — a blood vessel that carries oxygen-rich blood to the body — and it can occur anywhere within the body. When the artery becomes inflamed, narrowing or sometimes complete blockage of the blood vessel occurs. This narrowing or blockage deprives the surrounding tissues of an adequate amount of blood. If GCA affects the arteries that supply the eyes, blindness can develop suddenly in one or both eyes. On rare occasions strokes may result.
Symptoms of GCA can vary depending on the location of the inflammation and may include:
- Pain in the jaw or tongue muscles when eating or talking
- Tenderness of the scalp over the temples
- Loss of vision
- Double vision
- Unexplained weight loss
- Difficulty with coordination
- Difficulty with balance
Causes and Risk Factors
The cause of GCA is unknown. Because the condition almost always occurs in people over the age of 50 (the average age of patients with GCA is about 70), it may be related to the aging process. Genetic factors may also be involved since the condition is more commonly found in patients of Northern European ancestry. GCA occurs twice as often in women as in men.
The condition is also associated with polymyalgia rheumatica. About 15 percent of patients who have the condition are also diagnosed with GCA.
Diagnosis of GCA will begin with the physician performing a physical examination and recording the patient's medical history. Based on the physical exam, medical history and symptoms, the medical team may perform a biopsy of the temporal artery — the best way to diagnose the condition. During the procedure, a small amount of the artery will be removed using a needle. More than one sample may be taken because the condition does not occur everywhere within the artery. This sample is then examined under a microscope to see if the cells are abnormally large, indicating inflammation.
Imaging tests may be done to look at the blood vessels and the blood flow through them. This may include magnetic resonance angiography (MRA), Doppler ultrasound and positron emission tomography (PET). These imaging tests will also highlight any areas of inflammation.
Other diagnostic tests may include blood tests to look for an elevated "sed rate" — or erythrocyte sedimentation rate (ESR) — which looks at how fast the patient's red blood cells settle in a tube. When inflammation is present, the cells settle much more quickly.
Treatment of GCA will usually focus on relieving symptoms and preventing tissue damage. A corticosteroid such as prednisone is usually given to reduce inflammation. Treatment often takes two years or longer, and the dosage of the corticosteroid will be tapered off gradually as the treatment ends.
Corticosteroids can have negative side effects with prolonged use, especially in older patients — who are more often diagnosed with GCA — because they are already prone to certain conditions. These side effects may include:
- High blood pressure
- Muscle weakness
Other potential side effects of treatment may include:
- Weight gain
- Increased blood sugar levels, sometimes leading to diabetes
- Thinning skin and increased bruising
- Weakened immune system, leading to susceptibility to infection and delayed healing
The knowledgeable and highly trained staff at the Cedars-Sinai Heart Institute will work with each patient to determine the best treatment option.