Updated on 16/08/2023
Giant Cell Arteritis (GCA), also known as Temporal Arteritis, is a type of blood vessel inflammation that damages medium and large-sized arteries. The most commonly affected arteries are those that start from the neck and progress towards the scalp and head, and are particularly prone to occur in the carotid arteries that carry blood to the brain.
GCA is seen after the age of 50 and its incidence peaks in the seventh decade of life. It should be considered especially in individuals over this age who have newly developed headaches.
Headache is seen in more than two-thirds of patients. The pain, which can be mild or severe, tends to be located above the temples but can occur anywhere in the front or back of the skull. Some people also notice sensitivity in the scalp. Half of the patients experience jaw pain when chewing, which is due to insufficient blood flow to the muscles involved in chewing. When this symptom is observed, it is diagnostic. Temporary vision loss in one eye can occur in the early stages of the disease and should be treated rapidly to prevent permanent vision loss. More than 90% of visual loss is due to arteritic anterior ischemic optic neuropathy. Other symptoms that may occur include fever (less than 38ºC), fatigue, weight loss, a new cough and unexplained tooth or facial pain. A thoracic aortic aneurysm occurs when the aorta, the main artery that carries blood from the heart, develops a weak spot and bulges outwards. Aneurysms do not cause symptoms but can be life-threatening if they burst. Although rare, this condition is slightly more common in patients with DHA.
Erythrocyte sedimentation rate and C-reactive protein are elevated in most patients, but normal values do not exclude the diagnosis. The diagnosis of DHA should be confirmed by temporal artery biopsy. However, treatment should not be delayed because of the biopsy. In order to prevent irreversible vision loss, treatment should be initiated without waiting for diagnostic tests. Color Doppler ultrasound is another diagnostic tool but should be performed by clinicians specialized in this technique. In addition, CT or magnetic resonance angiography or fludeoxyglucose positron emission tomography (FDG-PET) imaging of large vessels can identify large vessel vasculitis.
Oral corticosteroids are used in treatment.