Giant Cell Arteritis or Temporal Arteritis
Giant cell arteritis, or GCA, is a disease of the blood vessels becoming inflamed in older adults, usually over the age of 60. GCA usually affects the blood vessels of the scalp and head, especially the arteries over the temples, and can affect the blood flow to an eye and loss of vision can occur rapidly after temporary blurring, double vision, or partial blindness.
For an older adult, a new persisting headache, especially if together with flu-like symptoms, marked fatigue, loss of appetite, weight loss, pains of the face, throat and jaw with chewing, and/or fevers could be due to GCA. GCA can occur with Polymyalgia rheumatica about 50% of the time. Blood tests show evidence of high inflammation tests. A biopsy of the temporal artery on the affected side is desired to establish the diagnosis.
Usually treatment with high dose corticosteroids begins before the biopsy and diagnosis is known to help preserve eyesight. Prednisone is usually started at 60 mg/day and tapered when symptoms are controlled. Most patients are down to 5-10 mg per day after a few months and continue this for 1-2 years. GCA rarely returns. Treatment with cortisone can cause higher blood sugar, weight gain, anxiety, sleeplessness, osteoporosis, cataracts, muscle weakness, bruising and thinning of the skin. DEXA scan testing for osteoporosis and checking for complications during therapy with corticosteroids is important. If corticosteroids cannot be lowered adequately, other medicines are added, such as Imuran or Actemra to help minimize the corticosteroid dose and side effects. The Vasculitis Foundation www.vasculitisfoundation.org/education/forms is available for more information.