Giant Cell Arteritis (Temporal Arteritis)

What is GCA?

Giant cell arteritis (GCA), also known as temporal arteritis, is an autoimmune condition which causes your body’s own defence system to mistakenly attack your own blood vessels causing inflammation. GCA commonly affects the arteries of the skull, particularly the temporal artery, and as such it is often referred to as temporal arteritis.

Symptoms of recurrence

As your doctor gradually reduces your dose of steroids there is a chance some symptoms may recur, these may include:

  • Severe headache, particularly over the temples
  • Scalp pain or tenderness when brushing your hair
  • Pain in the jaw or tongue when eating (claudication)
  • Temporary or permanent visual loss
  • Double vision

You may also experience fever, night sweats, unintentional weight loss and tiredness.

In the case of any new visual symptoms (especially loss of vision) you must attend the nearest Eye Casualty immediately.

In the case of new headache, jaw or tongue pain you must contact your GP immediately and be seen for a same day appointment within 24 hours of symptom onset.

What next?

There is a pathway for suspected giant cell arteritis (GCA) within the Ambulatory Emergency Care (AEC) unit. Whilst undergoing diagnostic tests, you will be treated with high dose steroids immediately (usually prednisolone tablets). This is necessary to reduce the risk of permanent visual loss but are not the same steroid taken by body builders. There are some side effects of steroids to be aware of – see section on managing the risks of steroid use.

Not all patients with suspected GCA have the condition. Blood tests, ultrasound and biopsy are required to make the diagnosis – these will be arranged by the team in AEC. The biopsy is a simple procedure performed by a surgical doctor with local anaesthetic to remove a small sample of artery from the scalp over the temple.

Further information at: https://www.versusarthritis.org/media/23085/giant-cell-arteritis-information-booklet.pdf

Follow up

If the diagnosis of GCA is confirmed, you will be followed up in the rheumatology clinic. You will need sever- al follow up appointments with your rheumatologist to monitor symptoms whilst they gradually reduce your steroid dose. You should keep taking the dose of steroid prescribed even if symptoms improve, as this can help prevent another episode. Steroid dose reduction can result in a relapse of the condition - if symptoms return please follow section on symptoms of recurrence. 

Managing the risks of steroid use

There are some side effects of steroid medication which your doctor will discuss with you. Whilst on steroid treatment your doctor will be mindful of your bone health and to protect your bones your doctor may recommend a mixture of lifestyle and medication changes:

  • Regular physical activity such as walking
  • Stop smoking
  • Bisphosphonates (medication) which are taken once per week
  • Calcium supplements
  • Vitamin D, recommended for all adults in the UK over winter

Steroids can also increase your blood sugar which increases your risk of developing diabetes and so you should ensure you eat a healthy diet.

For more information on how to keep a healthy lifestyle you can visit the NHS live well page at: https://www.nhs.uk/live-well/

Whilst on steroids you should carry a steroid card at all times, which alerts doctors that you require steroids should you become un- well and require hospitalisation.

During periods of illness you must double your dose of steroid for the duration of your illness and speak to your doctor if unsure. This includes diarrhoea, vomiting, fever, flu and dehydration.

Your doctor will discuss this with you before prescribing steroids.

Live vaccines

Whilst on steroid treatment you should take care not to have certain vaccines (with- out first speaking to your doctor) such as: 

  • Shingles
  • Yellow fever
  • Chickenpox

You should contact your doctor if you have not had chicken pox or shingles and come into contact with someone who has either infection as you may need antiviral treatment.

You are still able to take the COVID-19 and flu vaccine if desired. Steroid use can affect your ability to fight infections and so getting vaccinated against the flu and COVID-19 is especially important.

If you would like more information Versus Arthritis has an excellent page on steroid use which is linked here: https://www.versusarthritis.org/about-arthritis/treatments/drugs/steroids/

Contact us

To book appointments with the rheumatology clinic or to speak to reception staff please contact:

More information

The following websites are useful for further information on the diagnosis, management and treatment of GCA:

Contributors
Liz Alden