Giant cell arteritis
What is giant cell arteritis?
Giant cell arteritis (GCA), otherwise known as temporal arteritis, is a condition causing inflammation in the blood vessels. It is notably found in the arteries of the skull but can also be found in other parts of the body. It is a type of vasculitis at the more severe end of the spectrum.
What are the symptoms?
The most common symptoms are a severe headache and pain over the temple and scalp areas, and thickening and tenderness of the blood vessels around the temple. Other symptoms include anaemia and inflammation, fatigue, flu-like symptoms, and weight loss. A less common symptom is partial loss of vision, and in more extreme cases, complete loss of vision.
The symptoms can create complications for patients, such as pain when brushing their hair, shaving, and even when chewing and eating. In the more severe cases in which there is a loss of vision, patients’ day-to-day living will be affected, such as driving, reading, and other basic tasks.
How is it diagnosed?
The doctor will conduct a clinical examination to decipher the symptoms and rule out other related conditions. Blood tests will be done to assess the inflammation. The doctor may also wish to conduct a scan or biopsy of the temporal artery, in which a small part of the artery is removed and a microscopic examination is done.
What are the causes?
The precise cause of GCA is still unknown. Research has demonstrated that it is an autoimmune disease, which means it is due to a problem within the immune system when defence mechanisms attack healthy cells and arteries. Furthermore, there is evidence that there may be genetic factors involved.
Who gets the giant cell arteritis?
It is estimated about 1 in every 4,500 people will develop giant cell arteritis each year. It is very rare in people under the age of 50, and those who develop the condition are normally over 60. The condition is more common amongst women than men. White people of northern European extraction are seven times more likely than black people to develop the condition. Having polymyalgia rheumatica puts a patient at an increased risk of developing GCA. There is also an increased risk if the condition is found in other family members.
What treatments are available?
Despite GCA not being a curable condition, steroid treatment is usually prescribed to patients and is highly effective. Prednisolone is the primary steroid prescribed to patients and is normally given in a high dosage, to begin with. Patients are put on this medication as early as possible and sometimes before a diagnosis is confirmed, to avoid long-term consequences, such as loss of vision. If the steroid treatment is effective, normally after 3-4 weeks, the doctor will begin reducing the dosage whilst closely monitoring the patient. However, patients are likely to have steroid treatment for around 1-3 years.
Currently, steroids are the primary form of treatment for GCA. If the patient has a relapse, however, the doctor might advise additional treatment, including disease-modifying antirheumatic drugs, to help reduce the dose of steroids.
What are the benefits of treatment?
The benefits of treatment are the same for any rheumatological disease, namely to improve life expectancy and enhance quality of life. Since there is no cure for GCA, and some of the symptoms can be particularly serious like loss of vision, it is important to treat the condition early so patients can make a quick recovery and live normally. If there is a relapse, treatment tends to be highly effective at stopping the condition from persisting.
Are there any side effects of the treatment?
Prednisolone is a steroid drug, and like all steroids, there are notable side effects associated with them. Furthermore, GCA patients are given a particularly high dose, to begin with.
Around 5% of patients will experience changes in their mental state when they take the medication. They may feel depressed and suicidal, anxious or confused. Other side effects of prednisolone include increased appetite, which can lead to weight gain, increased blood pressure, changes in the mood, such as spontaneous aggression, weakening of the bones, stomach ulcers, and increased risk of infection. Patients may also have difficulties sleeping and concentrating.
If the patient is on steroids for a prolonged period of time, side effects may include thinning of the bones (osteoporosis), fractures, weight gain, muscle weakness, thinning of the skin and easy bruising, diabetes, high blood pressure, and cataracts and glaucoma. The doctor will want to regularly monitor the patient to look out for any side effects.
Are there any self-help measures the patient can do in addition to receiving treatment?
Patients should ensure a healthy lifestyle is maintained for general health and well-being first and foremost.
While GCA is not directly related to diet patients should make sure they eat healthily and, in particular, consume foods and supplements with plenty of calcium and vitamin D.
Foods high in calcium include dairy products, such as milk, cheese and yogurt, and certain nuts, beans and dried fruits. The current advice for people with GCA is at least 1000 mg of calcium a day, 1500 mg if they are over 60. Vitamin D helps the body to absorb calcium and is beneficial in maintaining healthy bones and immune system. This should involve at least 10-20 mg of vitamin D a day, through exposure to sunlight, eating foods such as oily fish, or supplements.
Patients should also maintain an active lifestyle with regular exercise. Not only will this help to avoid weight gain and muscle weakness as can be side effects to steroid treatment, but will also help prevent the patient from developing other related diseases such as osteoporosis. Patients often encounter fatigue whilst on treatment, and exercise and measure to increase energy levels are particularly beneficial to counteract tiredness and weakness.
Exercises that are particularly helpful are aerobic exercises, such as walking, which can also help prevent bone loss, high blood pressure and diabetes.
What is the outlook like for patients?
Provided patients have an early diagnosis and receive treatment quickly, patients can expect a good long-term outlook. However, patients have a 50% chance of relapse, and reducing the dose of steroids can lead to a relapse of symptoms in which case the treatment would be restarted. This may mean patients will be given a small dose of steroids for many years or the rest of their lives. Therefore, patients can lead normal healthy lives, provided they receive treatment ideally early on, are under regular monitoring by their doctor, and maintain a healthy lifestyle with a balanced diet and exercise.
Are there any recent research developments or discoveries to better understand and treat GCA?
Prednisolone is currently the only form of treatment. Studies have been done to try to find an alternative non-steroid drug which can be used to treat patients and avoid the side effects of steroids. Whilst clinical trials for possible new treatments, such as biologic therapies, have taken place, no alternative treatment has been found. Medical specialists are particularly interested in finding out the direct cause of GCA as this is unknown. Currently, research is being conducted to attempt to understand the types of inflammatory cells that are involved in GCA. If the nature of the inflammatory process can be better understood, this may lead to improvements in treatment.