What is it about ?
Giant cell arteritis is also called temporal arteritis. It is a condition characterized by inflammation of the arterial wall. The adjective “temporal” refers to the arteries at the temple, because that is where the inflammation occurs most often. However, all major arteries, such as the aorta and carotid arteries, can be affected. We also refer to inflammation of the blood vessels as vasculitis.
What is its frequency?
Giant cell arteritis affects between 17 and 24 in 100,000 people. At least half of people with giant cell arteritis have rhizomelic pseudopolyarthritis. The disease (s) occur after age 50, with a peak after age 70. It is three times more common in women than in men.
How to recognize it?
The main symptom of giant cell arteritis is a severe, throbbing, or throbbing headache (headache), usually in the temples, in a person over 50 years old. The scalp can be very sensitive to the touch, such as when combing the hair. This headache was absent before.
There is often visual disturbance at the same time (loss of vision up to loss of sight (blindness), double vision (diplopia), blurred vision, flashes of light). Hearing loss, ringing in the ears (tinnitus) and dizziness are possible. Sometimes the person feels pain when they chew or swallow, and their tongue hurts.
If the large arteries in the neck (carotids) are affected, it can disrupt blood flow to the brain and cause temporary paralysis. Inflammation of the body’s main artery, the aorta, can be associated with heart problems (pain on exertion) and even lead to heart attack. Inflammation of the arteries in the arms or legs can cause pain in the arms or legs during physical exertion.
In addition to these symptoms, more general complaints like fatigue, fever, loss of appetite, and weight loss may also appear.
How is the diagnosis made?
The doctor usually bases himself on the nature of the symptoms. There are abnormalities in the blood (such as inflammation), but there is no test to confirm the diagnosis. In case of giant cell arteritis, the doctor finds a painful, thickened and nodular artery in the temple during the clinical examination. The pulsations are not or less noticeable, and the skin is reddish in this area. Sometimes the technical examination (for example a ultrasound) shows abnormalities in the arteries.
The diagnosis of giant cell arteritis can only be confirmed by a temporal artery biopsy. To do this, the doctor takes a piece of the artery that is at least 2 to 3 cm for a laboratory analysis. In giant cell arteritis, we see large inflammatory cells (“giant cells”). Hence the name giant cell arteritis.
An eye exam can also identify certain abnormalities.
Because it is sometimes difficult to make the diagnosis, your doctor may suggest a trial cortisone treatment. Rapid improvement provides an additional argument in favor of the diagnosis.
What can you do ?
It is important to be aware of the nature of the disease. It can persist for months or even years and then go away, but it can just as easily come back. This can happen spontaneously or after reducing the dose of cortisone.
If your symptoms return, see your doctor quickly. Some symptoms, such as loss of sight (blindness), are indeed impossible to treat and are irreversible.
If you are taking cortisone for a long time, take enough calcium and vitamin D to preventosteoporosis.
What can your doctor do?
If the doctor suspects giant cell arteritis, he will refer you to a rheumatologist as soon as possible for confirmation of the diagnosis. If you have alarming eye symptoms, an ophthalmologist will examine you urgently.
A high dose of cortisone is the basis of treatment for giant cell arteritis, such as for rhizomelic pseudopolyarthritis. In the event of severe symptoms such as visual disturbances, cortisone is given by infusion in the hospital for the first 3 days. Usually, it improves symptoms and blood abnormalities quickly. But it does not reduce the duration of the disease. After 1 month, the dose is gradually reduced to the minimum effective dose, to be continued thereafter for at least 3 months. A basic treatment is then continued with a reduced dose for 1.5 to 2 years.
Cortisone can cause many side effects, such as increased blood sugar (blood sugar) and bone decalcification (osteoporosis). People with diabetes therefore receive a low dose of cortisone combined with an immunosuppressive drug.
This basic treatment is usually combined with a low dose of aspirin to prevent the formation of clots in the blood (thrombosis). In case of osteoporosis, your doctor will prescribe calcium and vitamin D and, if necessary, medication for osteoporosis.
Want to know more?
- Polymyalgia rheumatica and giant cell arteritis – Swiss League against Rheumatism
- Temporal artery biopsy – CHU Montreal
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