What are the symptoms of giant cell arteritis?

Symptoms of Giant Cell Arteritis

Giant cell arteritis (GCA) primarily presents with headache, scalp tenderness, jaw claudication, and temporal artery abnormalities in patients over 50 years of age, with jaw claudication being a highly specific symptom (positive likelihood ratio of 4.2). 1

Key Clinical Manifestations

Cranial Symptoms (Most Common)

• Headache: New-onset or change in headache pattern, often severe and localized to the temporal area 1, 2
• Scalp tenderness: Pain when touching the scalp, particularly over the temporal arteries 1, 2
• Jaw claudication: Pain in the jaw when chewing or talking, highly specific for GCA (positive likelihood ratio of 4.2) 1
• Temporal artery abnormalities: Thickening, tenderness, and/or reduced or absent pulsation of the temporal arteries 1
• Visual disturbances: Can include:
  • Sudden vision loss (potentially permanent if untreated)
  • Diplopia (double vision)
  • Amaurosis fugax (temporary vision loss) 3, 2

Systemic Symptoms

• Constitutional symptoms:
  • Fever (usually low-grade)
  • Fatigue
  • Malaise
  • Weight loss
  • Anorexia 1, 2
• Polymyalgia rheumatica: Occurs in approximately 40-60% of GCA patients, presenting with:
  • Proximal muscle pain and stiffness (shoulders, neck, hips)
  • Morning stiffness 1, 3
• Less common presentations:
  • Limb claudication (pain in extremities with use)
  • Respiratory symptoms: Chronic harsh, nonproductive cough (in <10% of cases) 1
  • Uveitis (rare presentation that may delay diagnosis) 4

Laboratory Findings

• Elevated inflammatory markers:
  • Erythrocyte Sedimentation Rate (ESR) >50 mm/hr (often >100 mm/hr)
  • Elevated C-Reactive Protein (CRP)
  • Thrombocytosis (platelet count >400 × 10³/μL) 1

Clinical Pearls and Pitfalls

• Age is a critical factor: GCA almost exclusively affects patients over 50 years of age, with peak incidence at 70-75 years 1, 3
• Headache alone is insufficient: While common, headache and scalp tenderness alone are poorly informative for diagnosing GCA 1
• Visual symptoms require urgent attention: Visual manifestations represent a medical emergency requiring immediate treatment to prevent permanent blindness 1, 2
• Atypical presentations can delay diagnosis: Some patients may present with less common symptoms like respiratory complaints or uveitis, potentially delaying diagnosis 1, 4
• No single symptom is diagnostic: No individual symptom, sign, or laboratory test can completely rule in or rule out GCA; clinical judgment and consideration of multiple features are necessary 1

Diagnostic Criteria

According to the American College of Rheumatology, diagnosis of GCA is supported by the presence of at least 3 of the following 5 criteria 1:

1. Age ≥50 years at disease onset
2. New-onset or new type of headache
3. Temporal artery abnormalities (tenderness, decreased pulsation)
4. Elevated ESR (>50 mm/hr)
5. Abnormal temporal artery biopsy showing vasculitis

Remember that prompt recognition and treatment are essential, as untreated GCA can lead to permanent vision loss and other serious complications 1, 3, 2.