With aging comes wisdom, but so come aches and pains. Some aches are simply due to wear and tear, but others may be the result of an inflammatory disease, like rheumatoid arthritis. Recognizing the difference is important as the treatments are very different. Some inflammatory diseases mimic other more common diseases, so it is important that your doctor keep these in mind and perform the proper tests to ensure that the right treatment is prescribed. Temporal arteritis, also called giant cell arteritis (GCA for short) is one of these diseases.
GCA is an autoimmune disease in which the cells that normally protect the body attack it instead. In this case, the cells turn against the lining of blood vessels causing inflammation and narrowing of those vessels that can ultimately lead to stroke and loss of vision. The symptoms of GCA, however, can mimic a headache, migraine, or trigeminal neuralgia. It is important that the GCA be treated immediately to prevent vision loss. Symptoms include, scalp tenderness, headaches, jaw pain with chewing, stroke-like symptoms, and transient loss of vision. The vision loss is given a special name because it almost always occurs in the same way in GCA. It is called amaurosis fugax, and refers to the sensation of a blind being pulled over the eye from top to bottom. It often comes and goes during the course of the disease, but can eventually lead to permanent loss of vision. It is caused by inflammation in the artery supplying blood to the eye.
According to the Primer on the Rheumatic Diseases published by the Arthritis Foundation, as many as 25 people in 100,000 are affected by GCA. However, the disease is nearly unheard of before the age of 50. It is truly a disease of aging and one that should be taken very seriously. While the consequences are serious, the treatment is almost 100% effective and consists of taking prednisone, a steroid. The treatment is so effective in fact, that studies have shown complete resolution of symptoms within 48 hours. Prednisone is so effective that it has been recommended as a means of diagnosing GCA. In fact, if the symptoms do not resolve within 48 hours of taking prednisone, it is likely that GCA is the wrong diagnosis.
If your doctor suspects GCA, there are several things that need to be done. First, something called an erythrocyte sedimentation rate (ESR) should be ordered. This is a blood test that is used to get a rough estimation of the level of inflammation in the body. Normally the ESR should be Definitive treatment can prevent the serious complications of GCA from occurring. As we all know, an ounce of prevention is worth a pound of cure. When dealing with your eyes and brain, nothing could be more accurate. Once treatment with prednisone is started and the disease is under control, your doctor will begin to wean you off the drug. Up to 60% of patients will have a relapse at some point during or after treatment according to the Arthritis Foundation publishing. The goal is to completely wean a person off of steroids while maintaining suppression of the disease. This is not possible in all cases, but careful trial and error testing between you and your doctor can reduce the dose of prednisone to the lowest possible dose while still maintaining remission.
In closing, GCA is a potentially life-threatening, but easily treatable disease. For more information regarding giant cell arteritis and the closely related polymyalgia rheumatica visit www.arthritis.org.
Source: Chapter 21 – Vasculitides: C. Giant Cell Arteritis, Polymyalgia Rheumatica, and Takayasu’s Arteritis. In: Klippel JH. Primer on the Rheumatic Diseases 12th ed. Arthritis Foundation: Atlanta, GA; 2001. P397 – 401.