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Giant cell arteritis

Definition


Disease: Giant cell arteritis Giant cell arteritis
Category: Cardiovascular diseases

Disease Definition:

The inflammation of the lining of the arteritis, the blood vessels that transport oxygen-rich blood from the heart to the rest of the body, is called giant cell arteritis (GCA). Arteries of the head, especially those of the temples are the ones that are usually affected. That’s why giant cell arteritis is sometimes called temporal arteritis or cranial arteritis.

 

Usually, jaw pain, blurred or double vision and headaches are caused by giant cell arteritis. Some of the most serious complications of giant cell arteritis include blindness, and in some rare cases, stroke.

 

The symptoms of giant cell arteritis including loss of vision are usually prevented by prompt treatment with corticosteroid medications. Within days of starting treatment, the patient should start feeling better.
 

Work Group:


Symptoms, Causes

Symptoms:

Head pain and tenderness, which usually occur in both temples and are severe, are the most common symptoms of giant cell arteritis. In some cases, people experience pain in the front of their head or only one temple.

 

The signs and symptoms of giant cell arteritis could vary. The onset of the condition could feel like the flu for some people, with muscle aches (myalgia), headache, fever and fatigue.

 

Listed below are some of the most common signs and symptoms of giant cell arteritis:

 

  • Double vision or decreased visual acuity
  • Fever
  • Unintended weight loss
  • Permanent loss of vision in one eye, which occurs suddenly.
  • Persistent head pain and tenderness, usually in the temple area
  • Pain and stiffness in the neck, arms or hips, which is usually worse in the morning before getting out of bed
  • Jaw pain, also called jaw claudications, when chewing
  • Scalp tenderness; combing hair could hurt or even laying the head on a pillow, particularly where the arteries are inflamed.

 

The symptoms of a related disorder called polymyalgia rheumatica also include pain and stiffness in the neck, arms or hips. Almost half of the people with GCA also have polymyalgia rhumatica.

 

The doctor should be visited in case a person develops a new and persistent headache or any of the problems that are listed above. If a person has been diagnosed with GCA, in order to help prevent blindness, treatment should be started as soon as possible.
 

Causes:

The arteries are pliable tubes that have thick and elastic walls. Through the body's main artery, namely the aorta, oxygenated blood leaves the heart. Then, the aorta subdivides into smaller arteries that deliver blood to all parts of the body, including the internal organs and brain.

 

In case someone has giant cell arteritis, some of these arteries may become inflamed, causing them to swell. However, it is still not known what exactly causes these arteries to become inflamed.

 

Despite the fact that almost any large or medium-sized artery could be affected, however, swelling mostly occurs in the temporal arteries that are located just in front of the ears and continue up into the scalp. Sometimes, the swelling could affect just a part of an artery with sections of normal vessel in between.
 

Complications

Complications:

These are some of the complications that could be caused by giant cell arteritis:

Angina:

Some people with GCA could have chest pain in some rare cases. Inflammation in the coronary arteries that supply the heart with oxygen and nutrients could cause this.

Stroke:

Sometimes, a blood clot could form in an affected artery and obstruct the flow of blood completely, depriving part of the brain of necessary oxygen causing a stroke. This is an uncommon complication of GCA, but is quite serious.

Aortic aneurysm:

A person's risk of having an aneurysm is doubled if they have giant cell arteritis. An aneurysm is a bulge that forms in a weakened blood vessel, mostly in the aorta, which is the large artery running down the center of the chest and abdomen. Because an aortic aneurysm could burst and cause life-threatening internal bleeding, it is a serious condition. The health of the aorta will probably be monitored with annual chest X-rays or other imaging tests, including MRI, CT scan or ultrasound because the aneurysm could sometimes occur even years after the initial diagnosis of GCA.

Blindness:

The swelling that giant cell arteritis causes narrows blood vessels and reduces the amount of blood, and therefore oxygen and vital nutrients that reach the body's tissues. When blood flow is diminished to the eyes, it will cause sudden and painless vision loss in one or, in some rare cases, both eyes. Blindness is usually permanent; it is the most serious complications of GCA.
 

Treatments:

High doses of a corticosteroid drug such as prednisone is what treatment for GCA consists of. The doctor is likely to start medication even before confirming the diagnosis with a biopsy because immediate treatment is necessary to prevent vision loss.

 

Despite the fact that the patient may need to continue taking medication for one to two years or longer, but he/she will probably start feeling better within just a few days. After the first month, the dosage will be gradually lowered, until it reaches the lowest needed dose to control inflammation as measured by CRP tests and sed rate. However, during this tapering period, some of the symptoms may return.

 

CORTICOSTEROIDS:

Corticosteroids are powerful anti-inflammatory drugs, the effects of which mimic those of hormones that are produced by the adrenal glands. These drugs could relieve pain effectively; however, a number of side effects could be caused by the prolonged use of these drugs, especially at high doses.

 

Because older adults are more prone to certain conditions that could also be caused by corticosteroids, those who are being treated for giant cell arteries are particularly at risk of these complications:

 

  • Cataracts
  • Osteoporesis
  • Muscle weakness
  • High blood pressure

 

These are some of the other possible side effects of cortisone therapy:

 

  • Increased bruising and thinning skin
  • Weight gain
  • Decreased function of the immune system
  • Increased blood sugar levels, which could sometimes lead to diabetes.

 

The patient's bone density will probably be monitored and they will be prescribed calcium and vitamin D supplements or other medications to help prevent bone loss, in order to counter the potential side effects of corticosteroid treatment. The patient's blood pressure is also likely to be monitored and they may be recommended diet changes, an exercise program and in some cases, medication in order to keep their blood pressure within a normal range. Usually when the corticosteroids treatment is stopped, most of the side effects will go away.

Emerging treatments:

Therapies that work as well as corticosteroids but with fewer side effects are being researched.

 

Methotrexate is one of the drugs that is under investigation. This medication is usually used to treat certain cancers and some inflammatory conditions, including rheumatoid arthritis. Researchers are hoping that it would be possible to use less prednisone to treat people with GCA when both methotrexate and prednisone are used. However, more research is needed because the preliminary research results are conflicting.

 

When used along with smaller doses of prednisone, a drug called azathioprine is suggested to be helpful in the treatment of giant cell arteritis. It has also been suggested that TNF (tumor necrosis factor) blockers, such as etanercept could be helpful. In order to confirm the effects of all of these medications, larger studies should be done.

 

Because when taken on a daily basis aspirin could reduce the risk of blindness and stroke, the patient should ask the doctor about taking low-dose aspirin. This is called anti-platelet therapy.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Clinical Trials:

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Consultants Corner

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology
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