Everything about Giant Cell Arteritis totally explained
Temporal arteritis, also called
giant cell arteritis (
GCA) is an
inflammatory disease of
blood vessels (most commonly large and medium
arteries of the head). It is therefore a form of
vasculitis. The name comes from the most frequently involved vessel (
temporal artery which branches from the
external carotid artery of the neck). The alternative name (giant cell arteritis) reflects the type of inflammatory cell that's involved (as seen on
biopsy).
The disorder may coexist (in one quarter of cases) with
polymyalgia rheumatica (PMR), which is characterized by sudden onset of pain and stiffness in muscles (
pelvis,
shoulder) of the body and seen in the elderly. Other diseases related with temporal arteritis are systemic
lupus erythematosus,
rheumatoid arthritis and severe
infections.
Symptoms
It is more common in females than males by a ratio of 3:1. The mean age of onset is about 70 years and is rare at less than 50 years of age.
Patients present with:
The inflammation may affect blood supply to the
eye and blurred vision or sudden
blindness may occur. In 76% of cases involving the eye, the
ophthalmic artery is involved causing
anterior ischemic optic neuropathy. Loss of vision in both eyes may occur very abruptly and this disease is therefore a
medical emergency.
Diagnosis
Physical exam
Palpation of the head reveals sensitive and thick arteries with or without pulsation.
Laboratory tests
Sedimentation rate is very high in most of the patients, but may be normal in approximately 20% of cases.
Biopsy
The
gold standard for diagnosing temporal arteritis is
biopsy, which involves removing a small part of the vessel and examining it
microscopically for
giant cells infiltrating the tissue. Since the
blood vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a
negative result doesn't definitely rule out the diagnosis.
Radiology
Radiological examination of the temporal artery with
ultrasound yields a
halo sign.
Contrast enhanced brain MRI and CT is generally negative in this disorder.
Treatment
Corticosteroids must be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy). Steroids don't prevent the diagnosis later being confirmed by biopsy, although certain changes in the histology may be observed towards the end of the first week of treatment and are more difficult to identify after a couple of months.
Further Information
Get more info on 'Giant Cell Arteritis'.
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