Giant Cell Arteritis (GCA), also called Temporal Arthritis, is an ischemic disease that causes inflammation in the walls of large vessels. The disease typically affects the vessels that supply the scalp and organs, such as the aorta (carotid artery), its major branches and its branches. Although the cause of the disease is unknown, advanced age is the most important risk factor identified.
Giant cell arteritis is inflammation of the walls of large blood vessels. The disease typically affects the vessels that supply the scalp and organs, such as the aorta (carotid artery), its major branches and its branches. This is why it is also called Temporal Arteritis. Although the cause of the disease is unknown, advanced age is the most important risk factor identified.
Giant cell arteritis causes headaches, skin disease, jaw pain and vision problems.
Complications of giant cell arteritis include blindness, aortic aneurysm and stroke. Vision loss due to the disease can be permanent; Aortic aneurysm can burst and become life-threatening. Stroke is a rare complication.
Although the exact cause of the disease is unknown, advanced age is the most important risk factor identified. In addition, female gender, family history, genetic predisposition, history of vascular disease, early menopause, smoking and low body mass index are other identified risk factors for GCA.
Early symptoms of giant cell arteritis include fatigue, loss of appetite and fever. Other symptoms of giant cell arteritis:
- New onset of headache, usually severe
- Tenderness of the scalp and/or temples
- Double vision
- Temporary or permanent loss of vision (as if a curtain is partially pulled over the eye)
- Dizziness or problems with coordination and balance
- Jaw and tongue pain when chewing and/or speaking
- Persistent sore throat or difficulty swallowing
- Occasional chest pain
It is the most common symptom in cases of giant cell arteritis. The resulting headache is often severe.
In addition to headache, tenderness occurs on the scalp or temples. Hair can become difficult to comb and style.
Symptoms of giant cell arteritis include vision problems. The patient may experience temporary or permanent loss of vision or double vision.
Giant cell arteritis can cause dizziness related to coordination and balance.
Symptoms of giant cell arteritis include jaw pain. This pain occurs when chewing or speaking.
It mainly affects the population over the age of 50 (with an incidence of about 20/100,000), with a peak incidence over the age of 70. GCA is approximately 3 times more common in women than in men (F/M: 3/1).
The disease predominantly affects northern Europeans, with a higher incidence reported in Scandinavian countries. Being Caucasian is associated with a higher prevalence of GCA.
If not recognized and treated early, GCA can lead to serious clinical complications.
Permanent visual impairment occurs in 10–15% of patients with GCA and the frequency increases with age (>79 years). The risk of aortic aneurysm and dissection is 2-fold increased compared to healthy controls and stroke occurs in 3-4% of patients. Approximately half of patients with giant cell arteritis may experience polymyalgia rheumatica (PMR), an inflammatory disorder characterized by widespread muscle pain.
Studies have shown that GCA patients may have a higher risk of heart attack, stroke and peripheral arterial disease.
Although the diagnosis of giant cell arteritis is largely based on symptoms and physical examination, the definitive diagnosis is made by temporal artery biopsy. If a patient over 50 years of age has the above-mentioned signs and/or symptoms, GCA should be considered as a possible option. Physical examination may reveal that the temporal artery is inflamed, tender and has a decreased pulse.
In case of findings supporting GCA on physical examination, temporal artery biopsy is performed. This involves removing a small piece of tissue from the top and front of the ear and examining it under a microscope. Sometimes more than one biopsy may be needed to make a diagnosis.
Giant cell arteritis should be treated as soon as it is diagnosed. Prompt treatment with high-dose corticosteroids reduces the risk of vision loss, which is highly critical in GCA. Symptoms of giant cell arteritis can be effectively controlled with high-dose corticosteroids treatment, but the corticosteroids treatment required to reduce inflammation can take months/years. Therefore, treatment with immunosuppressive agents may also be considered in order to reduce/stop the use of corticosteroids.
Once symptoms disappear and inflammatory markers in the blood return to normal, the risk of blindness is greatly reduced. Proper nutrition, physical activity, rest and following the prescribed medication regimen are important to manage the condition and combat possible side effects of corticosteroid therapy. Studies have shown that patients with GCA may have a higher risk of heart attack, stroke, aneurysm and peripheral arterial disease. Physicians and caregivers should be aware of this possibility even years after the diagnosis.
Conventional angiography, angiography, positron emission tomography and doppler ultrasonography can be used in the diagnosis of giant cell arteritis. For this reason, temporal artery biopsy can also be performed.
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