A Family Doctor's Tale - GIANT CELL ARTERITIS

DOC I HAVE GIANT CELL ARTERITIS

Giant Cell Arteritis is an inflammatory syndrome of cranial arteries especially the temporal artery.

It may be associated with blindness and may be part of the polymyalgia rheumatica syndrome.

It is rare under the age of 50 years.

Women are more affected than men.

There are some signs that Giant cell cell arteritis may be inherited because the illness have found to run in families.

The causes of Giant Cell Arteritis are:
The cause is unknown although it may be postulated that an immune response may have caused the inflammation.

It has been associated with severe infection and high doses of antibiotics.


There is inflammation of all layers of medium sized arteries within the carotid distribution from the neck, head, arms and even other arteries in the rest of the body.


The symptoms and signs of Giant Cell Arteritis are:
1.pain and tenderness of the scalp arteries with palpable thickening

2.headache and systemic upset such as weight loss

3.visual disturbance with loss of visual fields and blindness in severe cases

4.loss of appetite

5.Fever and sweating

6.weakness and fatigue

7.associated depression

8.claudication pain of jaw muscles while talking or eating

Other symptoms may be:

1.bleeding gums

2.mouth ulcers

3.hearing loss

4.joint pains of jaws, face and body

The Diagnosis of Giant Cell Arteritis is made by:
1.classical symptoms of headache and tenderness of the temporal arteries of the scalp


2.high ESR rate


3.biopsy of temporal artery under local anesthetic is diagnostic with multinucleared giant cells seen with fibrous proliferation of intima and fragmentation of elastic tissue

4.MRI of the brain

5.Ultrasound of the temporal arteries

The Complications of Giant Cell Arteritis are:

1.Development of aneurysm of blood vessels in the brain

2.Sudden transient ischemic attacks or stroke

3.sudden blindness of eyes or weakness of the eyelids

The Treatment of Giant Cell Arteritis is by using:
1.high dose corticosteroids (60mg prednisolone by mouth daily).

2.Dosage of corticosteroids can be reduced 2-3 weeks after symptoms disappear

3.maintenance dose of corticosteroids should be continues for six to eight months

Because of the prolonged use of corticosteroids, the bones may become porous and fragile:

1.additional calcium and collagen producing drugs are needed to strengthen the bones

2.walking and weight bearing exercises are needed

3.avoid smoking and alcohol

The Prognosis of Giant Cell Arteritis is:
Prognosis is good with prompt onset of corticosteroids treatment before loss of vision however treatment may be needed to continue for 1-2 years. Even then recurrence may occur.


Any loss of vision is irreversible once it occurred