From the Guidelines
Giant cell arteritis (GCA) typically presents with a combination of symptoms including headache, scalp tenderness, jaw claudication, visual disturbances, and systemic symptoms such as fever and fatigue, as supported by the most recent and highest quality study 1.
Key Symptoms
- Headache: a new, severe headache, typically located in the temples, that doesn't respond well to over-the-counter pain medications
- Scalp tenderness: particularly when combing hair or lying on a pillow
- Jaw claudication: pain while chewing or talking, experienced by about half of patients
- Visual disturbances: serious warning signs that may include blurred vision, double vision, or temporary or permanent vision loss
- Systemic symptoms: fever, fatigue, unintentional weight loss, and general malaise
Importance of Prompt Recognition
Prompt recognition of GCA is crucial as delayed treatment can lead to permanent blindness. If GCA is suspected, immediate medical attention should be sought for evaluation, which typically includes blood tests for inflammatory markers and temporal artery biopsy, as recommended by recent guidelines 1.
Diagnostic Considerations
The diagnosis of GCA is based on clinical presentation, pathologic abnormalities on temporal artery biopsy, and/or evidence of large vessel involvement on vascular imaging. Imaging and biopsy have similar diagnostic value if assessors are proficient in these techniques, as noted in the 2020 update of the EULAR recommendations for the management of large vessel vasculitis 1.
Management
High-dose glucocorticoid therapy is the mainstay treatment for GCA, with a starting dose of 40-60 mg/day prednisone-equivalent, as recommended by the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis 1. Tapering the glucocorticoid dose to a target dose of 15-20 mg/day within 2-3 months and after 1 year to ≤5 mg/day is recommended once disease is controlled.
From the Research
Signs and Symptoms of Giant Cell Arteritis (GCA)
The signs and symptoms of GCA include:
- Headache, particularly bitemporal headaches 2, 3, 4, 5
- Scalp tenderness or temporal artery tenderness 2, 3, 4, 5
- Jaw claudication 2, 3, 4, 5
- Polymyalgia rheumatica 2, 6, 3, 4
- Visual disturbances, such as diplopia, amaurosis fugax, or blindness 2, 6, 3, 4, 5
- Systemic symptoms, including fever, weight loss, and fatigue 3, 5
- Musculoskeletal pain 5
- Unusual clinical manifestations, such as lip, scalp, and tongue necrosis, carpal tunnel syndrome, claudication of the limbs, strokes, angina pectoris, myocardial infarction, hematuria, cough, or other CNS symptoms 5
Laboratory and Imaging Findings
Laboratory findings may include elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 3, 4. Imaging studies, such as duplex sonography, high-resolution magnetic resonance imaging, and positron-emission tomography, may also be used to diagnose GCA 3. Temporal artery biopsy is considered the gold standard for diagnosis 4.
Importance of Early Recognition and Treatment
Early recognition and treatment of GCA are crucial to prevent irreversible complications, such as permanent vision loss 2, 6, 3, 4, 5. Prompt treatment with corticosteroids can improve symptoms and reduce the risk of complications 6, 3, 4, 5.