What are the symptoms of giant cell arteritis and temporal arteritis?

Symptoms of Giant Cell Arteritis and Temporal Arteritis

Giant cell arteritis (GCA) and temporal arteritis refer to the same condition, characterized by new headache, scalp tenderness, temporal artery abnormalities, and systemic manifestations including polymyalgic symptoms, weight loss, fatigue, and fever. 1

Cranial Symptoms

• Headache: Often severe and persistent, typically localized in the temporal area 1
• Scalp tenderness: Painful sensation when touching the scalp 1
• Temporal artery abnormalities: Tenderness, thickening, and/or reduced pulsation of the superficial temporal arteries 1
• Jaw claudication: Pain in the jaw muscles when chewing or talking 1
• Tongue claudication: Pain in the tongue with use 1

Visual Symptoms

• Amaurosis fugax: Temporary vision loss 1
• Permanent visual loss: Occurs in 10-18% of patients 1
• Diplopia: Double vision 1
• Other visual manifestations: Anterior ischemic optic neuropathy, oculomotor cranial nerve palsy, central retinal artery occlusion, branch retinal artery occlusion, and choroidal ischemia 1

Systemic Symptoms

• Constitutional symptoms: Low-grade fever, malaise, weight loss (>2kg), fatigue, night sweats 1
• Polymyalgia rheumatica: Characterized by pain and stiffness in the shoulders, neck, and hips 1
• Limb claudication: Pain in the limbs with use 1

Respiratory Symptoms

• Chronic cough: Typically harsh and nonproductive, may be associated with sore throat, hoarseness, and tenderness of cervical structures 1
• Respiratory involvement: Occurs in <10% of cases and may precede the diagnosis of GCA 1

Rare Complications

• Stroke: Cerebral ischemia requiring rapid neurological evaluation 1
• Cranial nerve palsy: Affecting various cranial nerves 1
• Scalp necrosis: Tissue death in the scalp area 1
• Large-vessel aneurysms and stenoses: Affecting the aorta and its branches 1

Laboratory Findings

• Elevated inflammatory markers: Erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) are elevated in >95% of GCA cases at diagnosis 1

Important Clinical Considerations

• GCA almost exclusively affects individuals over 50 years of age 1
• Troublesome cough of "unknown etiology" and headaches in persons over 50 years should raise suspicion of GCA 1
• Prompt diagnosis and treatment are essential to prevent permanent vision loss 1
• Temporal artery biopsy is the gold standard for diagnosis, though imaging techniques are increasingly used 1
• Treatment with glucocorticoids should be initiated immediately when GCA is suspected, particularly in patients with visual symptoms 1

Warning Signs Requiring Urgent Attention

• New onset of visual symptoms requires immediate ophthalmological evaluation 1
• Signs of cerebral ischemia necessitate rapid neurological review 1
• Patients with both typical symptoms and increased inflammatory markers who present with acute visual disturbance should be treated immediately to prevent permanent blindness 1