Does an elderly person in your family, perhaps your mother, father, or grandmother, often complain about headaches? Does your eyesight seem a little weak at the same time? Then this is something that may be important to you. Today we are talking about a disease called Giant Cell Arteritis (GCA) , formerly known as Temporal Arteritis , which commonly affects adults. There is nothing to fear, the most important thing is to be aware of this.
What is GCA? Why can it be dangerous?
Simply put, Giant Cell Arteritis (GCA) is a condition that causes swelling in the large blood vessels in your body (especially those in the head, neck, and arms). Doctors also call it ``vasculitis.'' When blood vessels swell in this way, their walls thicken, narrowing the passageway for blood. Think of it like a water pipe that is blocked from flowing. When blood flow is disrupted in this way, it can damage the vital organs and tissues that are supplied with blood by those blood vessels.
The temporal arteries, located on either side of your forehead, supply blood to your skull, jaw muscles, and the optic nerve, which is the nerve that gives you vision. If GCA affects these temporal arteries, it can cause serious complications, such as blindness . GCA can also affect the aorta, the largest blood vessel in the body, and its branches. This swelling of the aorta is called aortitis, and can cause serious health problems.
GCA can occur in conjunction with another inflammatory disease, Polymyalgia Rheumatica, or PMR . We'll talk more about PMR later.
Is GCA really a serious condition?
Yes, GCA is a condition that can be serious if not diagnosed and treated early . This is because:
- Your eyesight may be damaged . You may suddenly lose your vision, or you may become blind in one or both eyes.
- Your blood vessels can be damaged . For example, a condition called an aneurysm, which is a blood vessel that bulges like a balloon and bursts, increases the risk of it bursting.
- Other conditions, such as stroke or transient ischemic attacks (also called "mini-strokes"), can occur.
That is why it is so important to be aware of these symptoms.
How common is GCA?
Although GCA is one of the most common types of vasculitis, it is a relatively rare disease overall. According to statistics in the United States, only 19-23 per 100,000 people suffer from this disease. Although there are no exact statistics in Sri Lanka, it is good to be concerned about this as the aging population increases.
What are the symptoms of GCA (Temporal Arteritis)?
The main and most common symptom of GCA is a persistent, severe headache that feels like a throbbing pain on one or both sides of the head . However, other symptoms may also occur:
- Tenderness when you place your hand on the scalp or forehead (above the ears).
- Jaw pain , especially when eating or chewing.
- Vision problems : Double vision, blurry vision, or sudden loss of vision for a short period of time.
- Fatigue .
- Fever .
- Loss of appetite or weight loss .
- Muscle pain : Pain in the shoulders, upper arms, hips, upper thighs, lower back, and buttocks.
Remember when I mentioned another condition that often accompanies GCA, Polymyalgia Rheumatica (PMR)? This is also a condition that causes swelling. PMR causes severe pain and stiffness , especially in the shoulders and hips. PMR can also occur on its own (it is more common for PMR to occur on its own than GCA). However, about 40-60% of people with GCA will also have PMR. Also, 10-20% of people with PMR alone will develop GCA later in life.
What causes GCA?
Researchers still don't know the exact cause of GCA, but many believe it's an autoimmune or autoinflammatory disease. Simply put, it's when your body's own immune system mistakenly attacks your healthy blood vessels .
This disease is most common in older people, so some people think it is related to aging. It is also thought to be caused by genetic factors and environmental factors (such as infections that affect the immune system).
Who is most affected by GCA?
Although anyone can develop GCA, the following people are most at risk:
- Elderly : GCA almost always affects people over the age of 50. The risk of developing the disease increases with age. It is most common in people between the ages of 70 and 80.
- Women : This disease is more common in women than in men. However, men are at higher risk of blindness due to this disease.
- White people : Research has shown that GCA affects white people of Northern European descent more often than other ethnic groups. However, this does not mean that other ethnic groups cannot develop it.
How is GCA diagnosed?
If you have symptoms of GCA, your doctor will first ask you about your medical history and then do a physical exam. They will check for weak pulses in your arms and legs. They will also examine your head to see if you have any pain in your scalp and if the arteries on either side of your forehead are swollen.
What tests are used to diagnose GCA?
The doctor will first order several blood tests to measure the level of inflammation in your body. For example:
- (Erythrocyte Sedimentation Rate) (ESR)
- `(C-Reactive Protein)` (CRP)
These tests can give you an idea of the level of inflammation in your body. They can also measure your levels of hemoglobin, the oxygen-carrying part of your red blood cells, to see if you have anemia.
If your doctor suspects GCA (Temporal Arteritis), they may order a temporal artery ultrasound, an ultrasound of the arteries in your forehead. Or, they may order a temporal artery biopsy . This involves a trained doctor taking a small sample of the artery in your forehead and sending it to a pathologist to examine under a microscope. This will check for signs of inflammation (vasculitis) in the artery. This is the main test to confirm GCA.
Sometimes these tests may also be needed:
- A ``(Computed Tomography)`` or ``(CT)`` scan test
- Magnetic Resonance Imaging (MRI) scan
- Ultrasound of the large arteries
- A `(Positron Emission Tomography)` or `(PET)` scan test
What are the treatments for GCA (Temporal Arteritis)?
Treatment for GCA should begin as soon as possible, especially to prevent vision loss .
The main treatment is a type of medication called a ``glucocorticoid''. The most common type of medication is ``prednisone.'' You will start with 40 to 60 milligrams (mg) a day (by mouth) and gradually reduce the dose. If you already have vision problems or vision loss, your doctor may give you high doses of ``glucocorticoids'' through a cannula placed in a vein (``(IV)'').
Important: Glucocorticoids are a very important medication for controlling GCA. However, these medications can cause some side effects, so your doctor will monitor you closely.
Glucocorticoids weaken your immune system, which can make you more likely to get infections and make them more severe . They can also thin your bones , increasing your risk of fractures.
Other side effects that may occur include:
- Cataracts
- High blood pressure
- High blood sugar
- Insomnia
- Mood swings
- Muscle weakness and wasting, especially in the legs
- Swelling, especially in the face and legs
- Weight gain
While you are taking glucocorticoids, your doctor may check your bone density. He or she may also recommend exercise, calcium and vitamin D supplements, and possibly medications to prevent osteoporosis (bone loss) to keep your bones strong.
In 2017, the U.S. Food and Drug Administration approved a new biologic drug called tocilizumab (Actemra®) for the treatment of GCA. This drug is given as an injection under the skin or as an IV. It can help reduce the need for glucocorticoids. However, tocilizumab has its own side effects, which your doctor will explain to you.
When should I see the doctor?
If you have symptoms of GCA, signs of an infection, or any new symptoms, see your doctor right away . Regular visits to your doctor and having blood tests and scans can help detect a relapse (`relapse`) early.
What questions should I ask the doctor?
You can ask your doctor questions like:
- What treatments do you recommend?
- What side effects should I be aware of during treatment?
- What can I do to reduce the side effects of treatment?
- What are the possible complications of this condition?
- How do I monitor my condition?
- What are the symptoms of relapse?
- What symptoms should I contact you for?
What is the life expectancy of someone with GCA?
Having GCA has not been found to shorten life expectancy, but various factors can affect this. If the disease is diagnosed and treated early, the outcomes are very good , and symptoms begin to improve within a few days.
However, if not treated promptly, GCA can lead to life-threatening complications such as permanent vision loss, aneurysms, and paralysis. Therefore, it is very important to see a doctor immediately if you have symptoms related to GCA.
Once treatment begins, the main risk you face is the side effects of the treatment . Also, even if GCA is initially cured with successful treatment, it can sometimes come back (`relapse`) . Researchers don't yet know why this happens.
How do I take care of myself while living with GCA?
Living with GCA can be challenging. To manage your condition and control the side effects of glucocorticoids, try these things:
- Eat a good, nutritious diet : things like lean meats, legumes, whole grains, fresh fruits and vegetables.
- Get enough vitamin D and calcium to protect your bones.
- Engage in some physical activity for at least 30 minutes a day.
- Get at least seven to eight hours of good sleep every night.
- Take the medicine prescribed to you on time .
- See your doctor regularly .
- Take steps to protect yourself from infections .
What things should I avoid when I have GCA?
If you have GCA, it's best to avoid these things:
- Factors that increase your risk of getting sick : Because the medications for GCA weaken your immune system, you are more likely to get infections. Ask your doctor about other ways to reduce your risk of infection, such as avoiding getting sick, washing your hands frequently, and staying away from people who are sick.
- Smoking : Smoking can increase your risk of developing GCA. The health of your blood vessels will improve as soon as you quit smoking, which will benefit you for life.
- Alcohol consumption : Alcohol can negatively affect the health of your heart and blood vessels. It can also accelerate bone loss and interact with medications you take for your condition.
Some very important points (Take-Home Message)
Giant Cell Arteritis (formerly Temporal Arteritis) can be a challenging condition. However, if you get diagnosed early and get regular checkups with a qualified doctor, you can have a much better outcome . The symptoms and side effects of the treatment can affect your mental health, your work, and many aspects of your life. But you are not alone. Ask your doctor to help you find a support group with people who have been through similar things. Sharing your experiences and advice with others can be a source of comfort.
Remember, if you have any unusual symptoms like headaches, jaw pain, or vision problems (especially if you are over 50), don't ignore it and seek medical advice immediately. Prompt treatment can prevent serious complications.
` Giant Cell Arteritis, Temporal Arteritis, GCA, Headache, Eyesight, Blood Vessel Swelling, Geriatric Health, Polymyalgia Rheumatica, Prednisone, Vasculitis
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