Giant Cell Arteritis

Giant cell artertis (GCA), also known as temporal arteritis, is an autoimmune disorder that causes inflammation of the medium and large arteries of the body.  Loss of vision due to temporal arteritis is commonly managed by a neuro-ophthalmologist.

This means that the blood vessels carrying blood to different parts of the body will start to swell inside and cause a decrease in the amount of blood that will reach certain organs. This decrease in blood flow can cause the organ to start to malfunction and can quickly cause permanent damage.  Because of the possibility of severe organ damage, it is important to recognize the disease quickly and start treatment as soon as possible.  This is particularly true regarding the eyes, where GCA can cause rapid, severe and permanent loss of vision.

Although GCA can affect both eyes, it usually affects one initially.  Therefore, by diagnosing the condition early and starting treatment immediately, the presenting eye may not sustain significant permanent damage, and the fellow eye may be spared any involvement.

This condition is more commonly seen in people over the age of 50.  It less commonly found in African-Americans.

Symptoms of Giant Cell Arteritis

  • Fever
  • Generalized “ill” feeling
  • Jaw pain that comes and goes or occurs when chewing
  • Loss of appetite
  • Muscle aches
  • Pain and stiffness in the neck, upper arms, shoulder, and hips
  • Throbbing headache on one side of the head or the back of the head
  • Scalp sensitivity, tenderness when touching the scalp
  • Vision difficulties
    • Blurred vision
    • Double vision
    • Reduced vision (blindness in one or both eyes)
  • Weakness and/or excessive tiredness
  • Weight loss (more than 5% of total body weight)

When GCA is suspected, your doctor will order some tests to help in the diagnosis. The most common are a complete blood count, C-reactive protein, and a sedimentation rate. These tests are looking for signs of inflammation in the body. The tests, however, are not specific for the disease as they can be elevated by any cause of increased inflammation in the body. Depending on the severity of your condition and the doctor’s clinical suspicion, treatment may be started before the results of the blood tests are obtained.

Temporal Artery Biopsy

If the results of the blood tests do not confirm the diagnosis, the next step in the workup is to take a biopsy of the temporal artery (in the superficial scalp, just above the ears) and have a pathologist look at the artery under a microscope to help with the diagnosis. If the disease is not confirmed, and there is still a high suspicion, further testing might be needed.

Treatment is with high dose steroids, which is often started by IV administration and then changed to oral. Due to the side effects of steroids it is important that your primary care doctor be informed of your steroid treatment so that your blood pressure and/or diabetes can be monitored.  Treatment can go on for several months, and occasionally, even longer. It is important that you keep all your follow-up appointments and immediately report any changes in your vision because there can be a reoccurrence of the disease once the therapy is stopped.

Jody Abrams, MD 

Neuro-ophthalmologist/Oculoplastic Surgeon

Sarasota Retina Institute

Sarasota, Florida

Comments

  1. hello my name is Wayne, I am a patient at your institute under Dr. Abrams. I have had a headache for one year, it is located at the back of the head with moderate to sever pressure 24-7. I have been diagnosed with polymyalgia rheumatic , Polycythemia and DVT; all with in a year and I am being treated for all three at this time.
    I have a history of neurological Lyme disease and was treated by Dr. Godofsky with iv antibiotics with a pic line in place for about 3 to 4 years; the treatment most every day. I take prednisone every day at 20 mg but it has been increased to 40 mg for a short time because, for lack of a better word, flare up’s.
    with out the prednisone I have all the symptoms listed above except: fever, lose of appetite and weight loss. with the prednisone, it controls most if not all the symptoms except the headache with severe pressure. The blurred and double vision started about one or two month ago and cane be pretty bad at times and seems to get worse with the headache and pressure; interfering with reading and driving. Dr. Abrams is treating symptoms with three types of eye drops. I have had a biopsy of the temporal arteries and it was negative.
    My question; can you test negative for Temporal arteritis and still have it and isn’t Polymyalgia Rheumatica and Temporal arteritis one in the same disease? Most literature seems to suggest this?

    Note: I was bitten by a tick last September 2013 while deer hunting. I became sick after being bitten by the tick. I have been tested but the test where negative. All symptoms started after this event.
    Thank you, signed: having trouble seeing :}

    • Jody Abrams, M.D. says:

      Wayne,
      I think with a case as complicated as yours we can discuss this again at your next visit.

      Jody Abrams, MD

    • Jody Abrams, M.D. says:

      Wayne,
      I think with a case as complicated as yours we can discuss this again at your next visit.

      Jody Abrams, MD

Trackbacks

  1. […] Giant cell arteritis or temporal arteritis is an inflammatory disease of medium sized arteries. This inflammation causes the opening of the artery to narrow and this decreases the blood flowing through the artery. The eye is supplied blood from medium sizes arteries so this makes it more likely to get affected then some other organs. This disease can cause irreversible blindness in both eyes in a period as short as a few hours. Promptly recognizing the disease and starting treatment are essential. […]

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