Giant cell arteritis is a systemic condition characterized by inflammation of large and medium sized blood vessels in the body. It occurs solely in patients over 50 years of age and mostly in patients over 70 years of age.
Symptoms of giant cell arteritis include vision loss, headaches, tiredness chewing food, scalp tenderness, loss of appetite, weight loss, and fever. Some patients only have a few of these symptoms or may only have vision loss. If vision loss occurs, it is usually irreversible, which is why it is important to diagnose giant cell arteritis before this happens.
Blood tests are important in assessing for giant cell arteritis. Platelet count, erythrocyte sedimentation rate (ESR) and C-reactive protein are often elevated and reflect inflammation in the body. To definitively diagnose giant cell arteritis, a biopsy of the temporal artery, which is located on the side of the head is required. The biopsied blood vessel is assessed under the microscope for signs of inflammation characteristic of giant cell arteritis.
Giant cell arteritis is treated with long-term steroids under the guidance of a rheumatologist. Steroids are typically started before the temporal artery biopsy to prevent vision loss and they usually do not affect the biopsy result. Patients are often on steroids for 1 to 2 years, but the exact timing depends on how symptoms respond and the results of blood testing. Other medications may also be used to help reduce the amount of steroids needed.
Although steroids are tolerated by most people, they have some side effects. These include difficulty sleeping, changes in mood, fluctuations in blood pressure and blood sugar and acid reflux. With long-term steroids, patients may experience weight gain, changes in bone density and cataracts.
In patients with new onset vision loss, a referral to a neuro-ophthalmologist may be required to determine the cause and whether testing for giant cell arteritis is required.