Giant Cell Arteritis (GCA)

What is giant cell arteritis?

When an older person complains of a new, persisting headache, especially if accompanied by flu‐like symptoms or weight loss, it can be due to a condition called giant cell arteritis (GCA). This disease of blood vessels can occur together with polymyalgia rheumatica (PMR).

GCA is a type of vasculitis or arteritis, a group of diseases whose typical feature is inflammation of blood vessels. In the case of GCA, the vessels most commonly involved are the arteries of the scalp and head, especially the arteries over the temples, which is why another term for GCA is “temporal arteritis.”

GCA can overlap with PMR. At some point, 5‐ 15% of patients with PMR will be diagnosed with GCA. Looked at another way, about 50% of patients with GCA have symptoms of PMR. The symptoms of the two conditions can occur at the same time or separately.

The most common symptom of GCA is a new headache, usually in the area of the temples, although headache due to GCA can occur anywhere, including the front, top and back of the skull. Almost as common are more generalized symptoms, such as unusual fatigue, loss of appetite, weight loss, a flu‐like feeling or fevers. Occasionally the only indication of GCA is a recurring, prolonged fever. Less common symptoms involve pain in the jaw when chewing or facial, tongue or throat pain.

If GCA spreads to the blood supply of the eye, vision can be affected. Visual symptoms include temporary blurring, double vision or actual blindness. Loss of vision in GCA can occur suddenly and usually cannot be reversed. What is important, however, is that this complication can be prevented with appropriate treatment. In fact, if vision is intact at the time treatment for GCA is started, the risk of visual loss is 1 in 100 or less. It is essential that patients who have PMR, either active or inactive, immediately report any symptoms of new headache, visual symptoms or jaw pain to their physicians.

Points to remember

• GCA, a disease of blood vessels, may occur together with polymyalgia rheumatica.
• New headache is a common symptom of GCA.
• Permanent loss of vision is a potentially serious complication of untreated GCA.
• High doses of corticosteroids are used for the treatment of GCA.