Giant cell arteritis (GCA), or temporal arteritis, is an inflammatory disease affecting the large blood vessels of the scalp, neck and arms. Inflammation causes a narrowing or blockage of the blood vessels, which interrupts blood flow. The disease is commonly associated with polymyalgia rheumatica.
GCA is a form of vasculitis. Vasculitis is defined as a condition in which blood vessels, particularly arteries, become inflamed. In GCA, the aorta and its branches are usually affected. The inflammation in GCA can cause swelling of the blood vessel wall and narrowing of the blood vessel lumen causing decreased blood supply to the neighboring tissues. The blood vessel may also become thrombosed causing severe ischemia or necrosis of tissues ordinarily supplied by the blood vessel.
The disease used to be called “temporal arteritis” because the temporal arteries, which course along the sides of the head just in front of the ears (to the temples) can become inflamed. However, it is also known that other blood vessels, namely the aorta and its branches, can also become inflammed. The term “giant cell arteritis” is often used because when one looks at biopsies of inflamed temporal arteries under a microscope, one often sees large or “giant” cells.
Age, gender and ethnicity are all risk factors for GCA. GCA affects people over the age of 50 years and the risk of GCA increases the older one gets. For reasons that are not clear, GCA is 2 to 3 times more common in women than in men. This condition is most commonly seen in people of Northern European descent and is rare in other ethnic groups like Asians and African Americans.
Causes
Temporal arteritis affects medium-to-large arteries. It causes inflammation, swelling, tenderness, and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It most commonly occurs in the arteries around the temples (temporal arteries) that branch off from the carotid artery in the neck. In some cases, the condition can occur in medium-to-large arteries in other places in the body as well.
The cause of the condition is unknown. It is believed to be due in part to a faulty immune response. The disorder has been linked to some infections and to certain genes.
Risk Factors
Several factors can increase your risk of developing giant cell arteritis, including –
- Age – Giant cell arteritis affects adults only, and rarely those under 50. Most people with this condition first experience warning signs between the ages of 70 and 80.
- Sex – Women are about two times more likely to develop the condition.
- Race and geographic region – Giant cell arteritis is most common among whites in northern European populations or of Scandinavian descent.
- Polymyalgia rheumatic – Having polymyalgia rheumatica puts you at increased risk of developing giant cell arteritis.
- Family history – Sometimes the condition runs in families.
Symptoms
Some common symptoms of this problem are –
- Throbbing headache on one side of the head or the back of the head
- Tenderness when touching the scalp
Other symptoms may include –
- Fever
- General ill feeling
- Jaw pain that occurs when chewing
- Pain in the arm after using it
- Muscle aches
- Pain and stiffness in the neck, upper arms, shoulder, and hips
- Weakness, excessive tiredness
Problems with eyesight may occur, and at times may begin suddenly. These problems include –
- Blurred vision
- Double vision
- Reduced vision (blindness in one or both eyes)
Other symptoms may occur with this disease, including –
- Cough
- Tongue or throat pain
- Hearing loss
- Joint stiffness
Complications
- Blindness – Diminished blood flow to the eyes can cause sudden, painless vision loss in one or, rarely, both eyes. Loss of vision is usually permanent.
- Aortic aneurysm – An aneurysm is a bulge that forms in a weakened blood vessel, usually in the aorta, the large artery that runs down the center of your chest and abdomen. An aortic aneurysm may burst, causing life-threatening internal bleeding. Because this complication may occur even years after the initial diagnosis of giant cell arteritis, the doctor may monitor the health of the aorta with annual chest X-rays or other imaging tests, such as ultrasound and CT.
- Stroke – This is an uncommon complication of giant cell arteritis.
Treatment
Prompt treatment with high doses of corticosteroids reduces the small but definite risk of blindness. As with polymyalgia rheumatica, the symptoms of giant cell arteritis quickly disappear with treatment, but corticosteroid therapy may be necessary for months to years to keep the inflammation down.
The Disease Modifying Anti-Rheumatic Drugs (DMARDs) are medications that are typically used to treat rheumatoid arthritis and other types of inflammatory arthritis. An example that has been shown effective in some people with giant cell arteritis is methotrexate.
Biologics are the newest class of medications that have been around for about a decade. These medications were specifically designed to target the immune system. A biologic called tocilizumab has shown some promising results in some people with giant cell arteritis. Before it can be used more widely, large studies are needed to confirm its role in managing the disease.
Alternative Treatment
Several nutritional supplements have been used in treating temporal arteritis, but further scientific testing may be required to prove the efficacy and mechanisms of action of these supplements. Calcium, vitamin D and bisphosphonate are nutritional supplements that may reduce the likelihood of experiencing these side effects. Ginger, hawthorn and ginkgo may also be helpful in restoring normal circulatory function
Hawthorn is a nutritional supplement that may be beneficial in treating the temporal arteritis and restoring the arterial health.
Reference –
http://www.sciencedaily.com/releases/2015/06/150615142841.htm
http://www.arthritisresearchuk.org/arthritis-information/conditions/giant-cell-arteritis.aspx
http://www.aao.org/eye-health/diseases/what-is-giant-cell-arteritis
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/eyes-giant-cell-arteritis
https://umm.edu/health/medical/ency/articles/temporal-arteritis
http://www.uveitis.org/docs/dm/giant_cell_arteritis.pdf
https://www.rcplondon.ac.uk/guidelines-policy/diagnosis-and-management-giant-cell-arteritis
http://emedicine.medscape.com/article/332483-treatment
http://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/basics/complications/con-20023109
http://www.naturalhomeremedysecrets.com/Temporal-Arteritis.html