What is giant cell arteritis and who does it affect?

Giant cell arteritis is a condition which causes inflammation on the inside of some arteries (blood vessels). It is called ‘giant cell’ because typical large cells develop in the wall of the inflamed arteries. The arteries commonly affected are those around the head and neck area. The artery most commonly affected is the temporal artery. (You have a temporal artery on each side of the head. They are under the skin to the sides of the forehead - the temple area.) Therefore, the condition is sometimes called ‘temporal arteritis’.

Giant cell arteritis is uncommon and mainly affects people over the age of 60. It rarely affects people under 50. Women are more commonly affected than men. The cause is not known.

What are the symptoms of giant cell arteritis?

• Headache is the common symptom. This may develop suddenly, or it can come on gradually over several days or weeks. The headache can be one sided, or on both sides, mainly towards the front and sides of the head.
  
• Tenderness of the scalp over the temporal arteries is common. You may be able to feel one or both of the inflamed arteries under the skin, or see them in a mirror.
  
• Other symptomsmay occur and include: pain in the jaw or tongue, particularly when you chew or talk; problems with vision such as blurred vision or sudden loss of vision for a short time. These occur if the arteries going to these parts of the body are inflamed, become narrowed, and reduce the blood supply to these areas.
  
• Some general symptoms may also occur. These include: tiredness, depression, night sweats, fever, loss of appetite, and weight loss.
  

Up to half of people with giant cell arteritis develop a related condition at the same time called polymyalgia rheumatica. If this develops you will also develop pain, tenderness and stiffness of muscle around the shoulders, hips and back. (See separate page called Polymyalgia Rheumatica). The treatment is similar for both conditions.

What are the possible complications of giant cell arteritis?

Complications are much less likely to occur if treatment is started soon after symptoms begin. Possible complications of untreated giant cell arteritis include the following:

• Blindness in one or both eyes. If an affected artery becomes very inflamed, the blood supply going down that artery can become blocked. The most common arteries this affects are the small arteries going to the eye. If one of these arteries becomes blocked it can cause permanent serious problems, even blindness.
  
• Rarely, a stroke or deafness may occur (caused by a blocked artery in the brain).
  
• Other serious complications occasionally develop if the inflammation occurs in other arteries. For example, a heart attack, an aortic aneurysm or damage to nerves.
  

Do I need any tests?

A blood test can detect if there is inflammation in your body. If the blood test shows a high level of inflammation, and you have the typical symptoms, then giant cell arteritis is likely. However, the blood test is not specific.

What is the treatment for temporal arteritis?

A steroid medicine such as prednisolone is the usual treatment. Steroids work by reducing inflammation. Treatment usually works quickly, within a few days. The improvement in symptoms over 2-3 days is often quite dramatic.

Treatment is usually started with a high dose – usually about 60 mg per day. Since high dose steroids have unwanted effects, including bone thinning and risk of stomach ulcers, you will be given additional medicines to protect you from these problems, while the steroid dose is high. The dose of steroid is then reduced gradually to a low ‘maintenance’ dose. It may take several months to gradually reduce the dose. It is important that you understand the risks and benefits of steroids. Further information is available in the Drug Information section of this website.

Sometimes an additional medicine is used as a “steroid-sparing agent”, to keep the symptoms at bay whilst allowing the dose of steroids to be reduced. Drugs which are used in this way include azathioprine and methotrexate.

You are likely to need treatment for at least two years. In some people the condition goes away, so the tablets can be stopped after 2-3 years. However, many people need treatment for several years, sometimes for life. If you stop taking the steroid medicine too soon, the symptoms return.

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