Giant cell arteritis ( GCA), also called temporal arteritis, is an inflammation autoimmune disease of large .[ GCA is frequently associated with polymyalgia rheumatica.][
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The cause is unknown.[ This mainly affects arteries around the head and neck, though some in the chest may also be affected.][ However, in about 10% of people the temporal artery is normal.][
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Treatment is typical with high doses of glucocorticoid such as prednisone or prednisolone.[ Once symptoms have resolved, the dose is decreased by about 15% per month.][ Once a low dose is reached, the taper is slowed further over the subsequent year.][ Other medications that may be recommended include bisphosphonates to prevent bone loss and a proton-pump inhibitor to prevent stomach problems.][
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It affects about 1 in 15,000 people over the age of 50 per year.[ The condition mostly occurs in those over the age of 50, being most common among those in their 70s.][ Females are more often affected than males.][ Those of northern European descent are more commonly affected.][ The first description of the condition occurred in 1890.]
Signs and symptoms
Common symptoms of giant cell arteritis include:
The inflammation may affect blood supply to the Human eye; blurred vision or sudden blindness may occur. In 76% of cases involving the eye, the ophthalmic artery is involved, causing arteritic anterior ischemic optic neuropathy.
Giant cell arteritis may present with atypical or overlapping features.
While studies vary as to the exact relapse rate of giant cell arteritis, relapse of this condition can occur.
Associated conditions
The varicella-zoster virus (VZV) antigen was found in 74% of temporal artery biopsies that were GCA-positive, suggesting that the VZV infection may trigger the inflammatory cascade.
The disorder may co-exist (in about half of cases) with polymyalgia rheumatica (PMR),
Giant cell arteritis can affect the aorta and lead to aortic aneurysm and aortic dissection.
Mechanism
The pathological mechanism is the result of an inflammatory cascade that is triggered by an as of yet undetermined cause resulting in in the vessel wall recruiting T cells and to form granulomatous infiltrates.
Diagnosis
Physical exam
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Palpation of the head reveals prominent temporal arteries with or without pulsation.
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The Temporal bone may be tender.
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Decreased pulses may be found throughout the body
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Evidence of ischemia may be noted on fundal exam.
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may be heard over the subclavian and Axillary artery arteries
Laboratory tests
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Erythrocyte sedimentation rate,
[ an inflammatory marker, >60 mm/hour (normal 1–40 mm/hour)
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C-reactive protein, another inflammatory marker, may be elevated
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LFTs, liver function tests, are abnormal particularly raised ALP- alkaline phosphatase
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Platelets may also be elevated
Biopsy
The gold standard for diagnosing temporal arteritis is biopsy, which involves removing a small part of the vessel under local anesthesia and examining it microscope for infiltrating the tissue.
Medical imaging
Radiological examination of the temporal artery with ultrasound yields a halo sign. Contrast-enhanced brain MRI and CT scan are generally negative in this disorder. Recent studies have shown that 3T MRI using super high resolution imaging and contrast injection can non-invasively diagnose this disorder with high specificity and sensitivity.
Early recognition
Women and men approximately 45 years old and who suffer from several complaints (at least 5 of the 16 symptoms)
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Fatigue and apathy
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Stiffness in joints and/or muscles
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Painful jaws when chewing
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Sensitive scalp
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Physical malaise and/or weakness
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Bloated arteries of the temples
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Headaches, migraine
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Tongue problems
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Bleakness, depression
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Changed eyesight
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Poor or lack of appetite
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Reduced eyesight, blindness
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Unusual loss of weight
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A temperature
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Unusual perspiration
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Night sweats
Treatment
GCA is considered a medical emergency due to the potential of irreversible vision loss.
Epidemiology
Giant cell arteritis typically only occurs in those over the age of 50;[ It is more common in women than in men, by a ratio of 2:1,]
Disease impact
Giant cell arteritis and its treatment impact on people's lives because of symptoms, adverse effects of GCs and disruption to normal life.
Terminology
The terms "giant cell arteritis" and "temporal arteritis" are sometimes used interchangeably, because of the frequent involvement of the temporal artery. However, other large vessels such as the aorta can be involved.
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