Giant Cell Arteritis (Temporal Arteritis)

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 abnormal 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.

• 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 symptoms may 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 muscles around the shoulders, hips and back. (See a separate leaflet 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 for giant cell arteritis (it can also be high in other 'inflammatory disorders'.) Also, some people with giant cell arteritis have a normal blood test.

To confirm the diagnosis a doctor may take a small part of the temporal artery (a biopsy) to look at under a microscope. If you have giant cell arteritis a doctor can see the inflammation and abnormal giant cells in the sample of the artery wall.

What is the treatment for temporal arteritis

If giant cell arteritis is suspected, treatment is usually started straight away. The main aim is to reduce the risk of possible complications. The second aim is to relieve the headache and any other symptoms. A steroid medicine such as prednisolone is the usual treatment. Steroids work by reducing inflammation. After starting treatment, symptoms usually ease quickly, within a few days.

A high dose of steroid is started at first, usually about 40 mg per day. This is then reduced gradually to a lower 'maintenance' dose. It may take several months to gradually reduce the dose. The maintenance dose needed to keep symptoms away and prevents complications varies from person to person. Usually it is around 10 mg per day.

In some people the condition goes away after 2-3 years, so the tablets may be able to be stopped after 2-3 years. This should always be done under supervision of a doctor. However, many people need treatment for several years, sometimes for life.

Some points about steroid tablets

• Do not stop steroid tablets suddenly. It probably does no harm if you forget to take the odd tablet. However, once your body is used to steroids, if you stop the tablets suddenly you may get serious withdrawal effects within a few days.
• Do not take anti-inflammatory painkillers whilst you take steroids unless advised by a doctor. The two together increase your risk of developing a stomach ulcer.
• Most people who take regular steroids carry a 'steroid card'. This gives details of your dose, condition, etc, in case of emergencies.
• If you are ill with other conditions, or have surgery, the dose of steroid may need to be increased for a short time. This is because you need more steroid during physical stress.

• Osteoporosis ('thinning of the bones') - but you can take a medicine to help protect against this if you are at increased risk (for example, if you are 65 or older, or have a history of fractures). Your doctor will advise.
• Weight gain.
• Increased chance of infections - in particular, a severe form of chickenpox. However, most people have had chickenpox in the past and are immune to it. If you have not had chickenpox, keep away from people with chickenpox or shingles. Tell a doctor if you come in contact with anyone with these conditions if you have not had chickenpox in the past.
• Increase in blood pressure. So, have your blood pressure checked regularly.
• High blood sugar.

Although the above points have to be mentioned, do not be put off about steroids. The relief of symptoms, and the prevention of serious complications, usually outweighs the risk of side-effects from the doses of steroids used for this condition.

© EMIS and PIP 2005   Updated: September 2005   PRODIGY Validated