Giant cell arteritis (GCA)

Key points about giant cell arteritis

  • Giant cell arteritis (GCA), also called temporal arteritis, is an uncommon but serious condition caused by inflammation of some of the arteries supplying blood to your head and neck.
  • The arteries most often affected are the temporal arteries, which are one each side of your forehead.
  • If the arteries become very inflamed, they can block the blood supply and sometimes cause permanent damage to the area the arteries supply. 
  • As the arteries that supply blood to the eyes can be involved, there is a risk of loss of vision or blindness if GCA isn't treated quickly.
  • GCA mainly affects people over the age of 50 years.
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A bad headache that is often worse at night is the most common symptom of GCA.

Other, less common symptoms include:

  • scalp tenderness, especially when combing your hair or resting your head on a pillow
  • pain in your jaw muscles when you chew
  • blurred vision or other vision problems.

See your healthcare provider if you are experiencing these. 

You may also feel generally unwell, eg, tired, depressed and feverish. You may be losing weight and not wanting to eat. These symptoms can appear well before a headache or other specific symptoms develop.

You may also have symptoms of polymyalgia rheumatica (PMR) which include pain and stiffness, especially around your shoulders and hips. This happens in about half of the people who get GCA.

Your GP will usually arrange a blood test to check for signs of inflammation, although other conditions can also cause this. Occasionally, your blood test can be normal when you have GCA.

If you have typical symptoms, and especially if you have signs of inflammation, you will need a temporal artery biopsy. This short procedure involves a surgeon removing a small piece of the temporal artery on the side of your face and looking at it under a microscope to check for inflammation. This is normally done under a local anaesthetic in hospital.

If your doctor thinks you may have GCA, you will be treated with high-dose steroid tablets (prednisone) while waiting for your test results. You can expect to feel better in a few days, but GCA needs treating for a long time to prevent it flaring up.

There are several ways to treat giant cell arteritis (GCA).

Steroid tablets (prednisone)

If your doctor thinks you have giant cell arteritis, they'll start you on high-dose steroid tablets (prednisone) straight away to avoid the small chance of you losing your eyesight. Steroids work by reducing inflammation. You can expect to feel better after a few days' treatment.

You will need to stay on a high dose of steroids for several weeks before slowly reducing the dose to a lower maintenance dose. This can take several months. If your symptoms come back, you will need to increase the dose again.

Most people will need to keep taking steroids for 1-2 years, and some even longer. Taking steroids for this long can have side effects. See prednisone (oral steroids) for details about the side effects and what you should do about them.

Low-dose aspirin

You may need to take low-dose aspirin to help reduce the chance of complications from GCA such as a stroke or transient ischaemic attack (TIA).

Stomach medication

If you are taking both prednisone and aspirin you will need a proton pump inhibitor (PPI) to help protect your stomach lining. The common ones are omeprazole and pantoprazole.

Bone protection

Taking prednisone for a long time can cause thinning of your bones, possibly leading to osteoporosis. To prevent this you can take vitamin D tablets or bisphosphonates.

Other treatments

If your GCA doesn’t respond well to prednisone, or if you are needing high doses, you may be referred to a rheumatologist to consider other medication such as methotrexate or azathioprine or tocilizumab.

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Credits: Content shared between HealthInfo Canterbury, KidsHealth and Healthify He Puna Waiora as part of a National Health Content Hub Collaborative.

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