What are the symptoms of giant cell arteritis?

Symptoms of Giant Cell Arteritis

Giant Cell Arteritis (GCA) presents with a characteristic pattern of symptoms including new-onset persistent localized headache (often in the temporal area), jaw and tongue claudication, acute visual symptoms, constitutional symptoms, and polymyalgia rheumatica symptoms. 1, 2

Cranial Symptoms

• Headache: New-onset or change in headache pattern, often localized to the temporal area 1
• Scalp tenderness: Sensitivity when touching the scalp 1
• Temporal artery abnormalities:
  • Tenderness and/or thickening of the superficial temporal arteries
  • Reduced pulsation
  • Cord-like thickening/nodularity 1

Visual Manifestations

• Acute visual symptoms 1, 2:
  • Amaurosis fugax (transient visual loss)
  • Diplopia (double vision)
  • Blurring
  • Permanent partial or complete visual loss
  • Field defects
  • Blindness
• Ophthalmologic findings 1:
  • Anterior ischemic optic neuropathy
  • Oculomotor cranial nerve palsies
  • Central retinal artery occlusion
  • Branch retinal artery occlusion
  • Choroidal ischemia

Oral and Jaw Symptoms

• Jaw claudication: Pain in the jaw when chewing or talking 1
• Tongue claudication: Pain in the tongue with use 3
• In severe cases, tongue necrosis may occur (rare) 3

Constitutional Symptoms

• Fever/pyrexia (low-grade) 1, 2
• Weight loss (>2 kg) 1, 2
• Fatigue 2
• Night sweats 1
• Malaise 2

Polymyalgia Rheumatica Symptoms

• Muscle pain and stiffness, particularly in the shoulders and hips 1, 2
• Morning stiffness 2

Vascular Symptoms

• Reduced pulses/blood pressure of the upper limbs 1
• Bruits (particularly in the axilla) 1
• Limb claudication 1

Neurological Manifestations

• Stroke (rare presenting symptom) 4
• Cranial nerve palsies 1

Laboratory Findings

• Elevated erythrocyte sedimentation rate (ESR) (>50 mm/h in >95% of cases) 2
• Elevated C-reactive protein (CRP) (in >95% of cases) 2
• Anemia (decreased hemoglobin) 1

Important Clinical Considerations

• GCA primarily affects adults over 50 years of age 2
• Prompt diagnosis is critical as delayed treatment can lead to permanent visual loss in 15-35% of untreated patients 2
• Visual loss, once established, is often irreversible if treatment is not initiated within a few days 5
• Atypical presentations can occur, including uveitis 6 and stroke 4, which may delay diagnosis

Common Pitfalls in Diagnosis

• Focusing only on classic symptoms while missing atypical presentations
• Delaying treatment while awaiting biopsy results, which can lead to irreversible complications
• Overlooking GCA in patients with normal inflammatory markers (ESR/CRP), as these can occasionally be normal early in the disease
• Failing to consider GCA in elderly patients with unexplained ischemic symptoms in various organ systems

Early recognition and prompt treatment with high-dose glucocorticoids are essential to prevent irreversible complications, particularly permanent vision loss.