Neuro-Ophthalmology
Giant Cell Arteritis

Giant cell arteritis (GCA) is an inflammation of the lining of your arteries, most commonly those arteries in your head and temples.   For this reason, GCA is also sometimes called temporal arteritis.  The cause of GCA is unknown. 

Symptoms
1.  Persistent head pain and tenderness, usually in the temple area
2.  Blurry vision, double vision or sudden, complete loss of vision
3.  Flu like symptoms such as muscle aches, fever and fatigue
4.  Jaw pain when chewing
5.  Scalp tenderness when combing your hair
6.  Unintended weight loss
7.  Pain and stiffness in your neck, arms or hips which is usually worse in the morning.   These are common symptoms of a related disorder, polymyalgia rheumatica (PMR).   Approximately half the people with GCA also have the arthritic condition PMR.

Risk Factors
1.  Age - GCA affects adults over the age of 55
2.  Sex - women are two to three times more likely to develop GCA than men
3.  Race - any race can be affected but people of Scandinavian origin are particularly at risk
4.  PMR - up to 15% of people with PMR also have GCA

Complications
1.  Blindness is the most serious complication of GCA.  One or both eyes may experience sudden, painless and permanent vision loss.
2.  Aortic aneursym - Having GCA doubles your risk of developing an aneurysm which can cause life-threatening internal bleeding if it bursts.

Diagnosis
1.  Physical exam - often one or both temporal arteries are tender with a reduced pulse
2.  Blood tests - both the CRP and ESR will be elevated
3.  Biopsy - the only way to confirm the diagnosis is by taking a small sample (biopsy) of the temporal artery.  This procedure can be done by your ophthalmologist as an outpatient under local anesthesia.  Unfortunately, a biopsy isn't foolproof.  It is possible for you to have GCA and still have a negative biopsy result.  If the results aren't clear, your doctor may advise a biopsy on the other side of your head.

Treatment
Treatment for GCA consists of high dose steroids such as prednisone.  Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.
You shoud start to feel better within just a few days, but you may need to continue taking medication for one to two years or longer. 

Side effects of prednisone
1.  Osteoporosis (thinning of the bones)
2.  High blood pressure
3.  Muscle weakness
4.  Cataracts
5.  Glaucoma (increased eye pressure)
6.  Increased appetite and weight gain
7.  Increased blood sugar levels, sometimes leading to diabetes
8.  Thinning skin and increased bruising
9.  Decreased function of your immune system
10.  Stomach ulcer/increased stomach acid/heartburn

 


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