Giant cell arteritis (GCA), also known as temporal arteritis, is a form of vasculitis characterized by inflammation of the arteries, particularly those in the head and neck. This condition predominantly affects individuals over the age of 50, with the average age of onset around 70. While GCA primarily impacts the arteries in the temples, leading to severe headaches, it can affect almost any large or medium-sized artery in the body. Prompt diagnosis and treatment are crucial to prevent serious complications, such as vision loss and aortic aneurysm.
Understanding Giant Cell Arteritis
GCA is an inflammatory condition where the lining of the arteries becomes inflamed, causing them to swell. Although the exact cause of this inflammation remains unknown, it is believed to involve abnormal immune system attacks on artery walls. This immune response leads to narrowing of the blood vessels, which can affect blood supply to various organs and tissues.
GCA often overlaps with another condition called polymyalgia rheumatica (PMR). Approximately 40-60% of patients with GCA also experience symptoms of PMR, which include pain and stiffness in the neck, shoulders, or hips. Both conditions predominantly affect older adults, particularly women of Caucasian descent.
The incidence of GCA varies geographically, with the highest rates reported in Scandinavian countries and Minnesota (USA). Mediterranean, Asian, and Arab countries have the lowest reported incidence. Genetic factors are believed to play a role in the development of GCA, although the exact mechanisms are still under investigation.
Symptoms of Giant Cell Arteritis
The symptoms of GCA can be varied and may change over time, making diagnosis challenging. The most common initial symptom is a new, persistent headache, affecting 40-90% of patients. This headache is often severe and localized around the temples. Other common symptoms include:
Read also: Benefits of couples massage detailed
- Scalp tenderness, often noticed when brushing hair, washing hair, or sleeping on one side of the head.
- Jaw pain, ear pain, tongue pain, throat pain, or neck pain while chewing or swallowing, especially after doing so for a few minutes.
- Vision problems, such as double vision or temporary blurring of eyesight in one eye.
- Fatigue and generalized malaise.
- Fever, loss of appetite, and unintentional weight loss.
In severe cases, GCA can lead to serious complications such as heart attack, stroke, kidney damage, and aortic aneurysm. Diminished blood flow to the eyes can cause sudden, painless vision loss in one or, rarely, both eyes.
The Link Between Giant Cell Arteritis and Weight Loss
Unintentional weight loss is a notable symptom of GCA. Many people with GCA experience nonspecific symptoms such as fatigue, generalized malaise, fever, loss of appetite, or decreased appetite. These symptoms can contribute to a significant reduction in food intake, leading to weight loss.
A study using data from the Malmö Preventive Medicine Program (MPMP) and the Malmö Diet Cancer Study (MDCS) found an association between lower body mass index (BMI) and an increased risk of GCA. The study revealed that individuals who developed GCA had a significantly lower BMI at baseline compared to controls. A higher BMI was associated with a significantly reduced risk of subsequent development of GCA. This suggests that a lower BMI may be a predictor of GCA.
Diagnosis of Giant Cell Arteritis
Diagnosing GCA can be challenging due to the variability of symptoms and the lack of a single definitive test. If a doctor suspects GCA, they will typically perform a physical exam and order blood tests to screen for inflammation. Common blood tests include:
- Erythrocyte Sedimentation Rate (ESR): Measures the rate at which red blood cells settle in a test tube, which can indicate inflammation in the body.
- C-reactive protein (CRP): Another marker of inflammation in the body.
- Complete Blood Count (CBC): Assesses overall blood health and can reveal abnormalities that may suggest inflammation.
In addition to blood tests, imaging tests such as ultrasound may be used to visualize the temporal arteries and assess for inflammation. However, the gold standard for diagnosing GCA is a temporal artery biopsy. This procedure involves removing a small segment of the temporal artery and examining it under a microscope for signs of inflammation.
Read also: How digestive health affects weight loss
Treatment of Giant Cell Arteritis
Prompt treatment is essential to prevent serious complications of GCA, particularly vision loss. The primary treatment for GCA is high-dose corticosteroids, such as prednisone. These medications effectively control inflammation and often provide rapid relief from symptoms like headache and pain.
The typical initial dose of prednisone is 40-60 mg per day. This high dose is usually maintained for 2 weeks, after which the dose is gradually tapered. The speed of the taper is adjusted based on the patient's symptoms and blood test results (ESR and CRP). In most cases, the prednisone dose can be reduced to about 5-10 mg per day over several months, and eventually discontinued entirely.
Corticosteroids can have significant side effects, including bone loss, weight gain, poor sleep, muscle weakness, cataracts, and skin bruising. To protect against bone loss, supplements of calcium and vitamin D are recommended. Bisphosphonate medications (alendronate, Reclast, and others) may also be prescribed.
Tocilizumab (Actemra), a newer medication, has been approved for the treatment of GCA. It is administered either by self-injection or by intravenous infusion, and can be used in conjunction with prednisone. Tocilizumab can be particularly helpful in patients who develop side effects from prednisone or experience recurring symptoms during the steroid taper. It can also be started at the same time as prednisone in certain situations where side effects are anticipated, such as in patients with pre-existing diabetes mellitus or significant osteoporosis.
Prognosis and Management of Giant Cell Arteritis
With early diagnosis and prompt treatment, GCA has a good prognosis for survival. However, vision loss is often permanent, even with treatment. Therefore, it is crucial to seek medical attention immediately if you experience any symptoms of GCA.
Read also: Weight Loss Meds & BCBS
Long-term management of GCA involves regular monitoring of symptoms and blood tests (ESR and CRP) to assess disease activity. The steroid dose is gradually lowered as the inflammation improves. Many people with GCA require long-term steroid treatment, sometimes for several years.
Living with Giant Cell Arteritis
Living with GCA can be challenging due to the chronic nature of the condition and the potential side effects of treatment. However, with proper medical care and lifestyle adjustments, people with GCA can maintain a good quality of life.
It is important to work closely with your healthcare provider to manage symptoms and minimize side effects. Regular exercise, a healthy diet, and stress management techniques can also be beneficial. Joining a support group can provide emotional support and connect you with others who understand what you are going through.