Giant cell arteritis
Giant cell arteritis (GCA), also known as temporal arteritis, is an inflammatory disease of medium-sized vessels, and as the name suggests, it usually affects the temporal artery.
Giant cell arteritis (GCA), also known as temporal arteritis, is an inflammatory disease of medium-sized vessels, and as the name suggests, it usually affects the temporal artery.
It is a condition that affects patients over the age of 50 (and in most cases over 70), while women are 2 times more likely to develop it. Patients with polymyalgia rheumatica have an increased risk of developing the disease.
Anterior ischemic optic neuropathy is a pathological condition of the optic nerve that is closely linked to temporal arteritis, causing ischemia of the optic nerve and irreversible vision loss.
GCA can cause sudden, painless loss of vision. Symptoms that often coexist are headaches, pain in the temples, fatigue, weight loss, pain when chewing and scalp tenderness.
Early and accurate diagnosis is extremely important, as without treatment the other eye can become affected in a short period of time.
A thorough history, physical examination and laboratory tests are all equally important. Erythrocyte sedimentation rate (ESR) and CRP are inflammatory markers that are universally elevated in patients with GCA.
A temporal artery biopsy is often needed to confirm the diagnosis. This can be performed by an Oculoplastic surgeon, who can safely remove part of the temporal artery through a thin incision in the scalp.
If GCA is suspected, the patient should receive high-dose systemic steroids (prednisone) right away. Treatment should never be delayed while waiting for a temporal artery biopsy or lab results, as even a few hours can make the difference in preserving a patient's sight.
Multidisciplinary Care
A referral to a rheumatologist is essential for long-term management. The rheumatologist will:
- Monitor the patient’s systemic health: Managing the side effects of long-term steroid use.
- Taper the dosage: Gradually reducing the steroids over several months or years while ensuring the disease remains in remission.
- Introduce Sparing Agents: They may suggest the use of modern biologic agents (such as Tocilizumab).
For more information about giant cell arteritis, Oculoplastic surgeon Dr. Ioannis Chalkias is available to assist you.
