Giant Cell Arteritis – Diagnosis and Treatment
Diagnosis
Laboratory Examinations
Doctors often use different blood tests to help determine if someone has giant cell arteritis (GCA). These tests do not confirm the diagnosis by themselves, but they give clues and support other findings.
Two of the most common blood tests are:
- Erythrocyte Sedimentation Rate (ESR): This test checks how quickly red blood cells settle at the bottom of a tube over one hour. A faster sedimentation rate may mean there is inflammation in the body. Many people with GCA have a high ESR.
- C-Reactive Protein (CRP): The liver produces this protein, and its levels increase with inflammation. High CRP levels often appear in GCA and help clarify the illness when combined with other test results.
Doctors may order both tests to increase accuracy since some people may have normal levels in one but not the other. These blood tests also help monitor progress during treatment, as falling levels can show improvement.
Table: Main Blood Tests in Giant Cell Arteritis
| Test Name | What It Shows | Use in GCA |
|---|---|---|
| ESR | Inflammation level | Diagnosis, Monitoring |
| CRP | Liver response to inflammation | Diagnosis, Monitoring |
Medical Imaging Approaches
Imaging studies help doctors look directly at the blood vessels. These scans can reveal swelling, narrowing, or inflammation, which supports the diagnosis of giant cell arteritis. Some standard imaging methods include:
- Doppler Ultrasonography: This noninvasive test uses sound waves to create images of blood moving through arteries, including the temporal arteries. It helps spot changes in blood flow or vessel wall thickness.
- Magnetic Resonance Angiography (MRA): This scan uses magnets and a contrast dye to create detailed pictures of blood vessels. Doctors use it to see deeper or larger arteries, such as the aorta, and to check for involvement of medium or large arteries.
- Positron Emission Tomography (PET): Doctors inject a small amount of radioactive tracer to help this scan spot inflammation in larger vessels throughout the body, particularly in the aorta and its branches.
Doctors choose the right imaging approach based on clinical suspicion and which arteries they think might be affected. Sometimes they use more than one type of scan to get clearer information.
Tissue Sample Evaluation
Doctors confirm giant cell arteritis most reliably by removing and examining a small section of the temporal artery, known as a temporal artery biopsy. This artery runs just in front of the ear and moves up to the scalp.
During the procedure, a local anesthetic numbs the area. The doctor then removes a tiny piece of the artery and examines the sample under a microscope for signs of inflammation, including areas packed with large, abnormal cells called “giant cells.”
Their presence supports the diagnosis.
A person can still have giant cell arteritis even if the first biopsy is negative, especially if arteries are not affected evenly. If suspicion remains high, doctors might take a sample from the other side.
A healthcare facility usually performs the biopsy, and patients do not need a hospital stay. Most people heal quickly, and scarring is minimal.
Points to Remember:
- Biopsy is the gold standard for diagnosis.
- The test checks for inflamed artery tissue and giant cells.
- Sometimes, more than one biopsy is needed.
Doctors use a combination of personal history, physical exams, blood tests, imaging, and biopsy results to accurately identify giant cell arteritis and decide next steps.
Treatment
Doctors start high doses of corticosteroids as soon as possible to treat giant cell arteritis (GCA), also known as temporal or cranial arteritis. Quick treatment prevents vision loss and reduces other risks, such as stroke or blindness.
Doctors may prescribe medication even before confirming GCA through a biopsy due to the urgent need to protect eyesight.
Most people notice improvement in symptoms—such as headache, double vision, or blurred vision—within a few days of beginning therapy. However, if vision loss has already happened before treatment, it may not recover.
The unaffected eye may help compensate for some vision changes, but preventing further damage is the main goal.
Treatment usually lasts for one to two years or longer. After the initial phase, the doctor often lowers the corticosteroid dose slowly to the lowest level that keeps inflammation under control.
Flares—including headaches or new symptoms such as those seen in polymyalgia rheumatica—can occur while tapering the dose. These are usually managed by slightly increasing corticosteroid therapy or by adding an immunosuppressive medication to help control inflammation.
Common Treatments
| Medication | Purpose | Notes |
|---|---|---|
| Corticosteroids | Controls inflammation | High doses at first, then tapered down |
| Immunosuppressive medication | Suppresses immune system | Sometimes added to steroid therapy |
| Biological agent | Reduces immune response | Injected; lowers inflammation |
| Low-dose aspirin | Reduces risk of complications | Used to help prevent strokes |
| Bisphosphonate class | Prevents bone loss | Often needed with long-term steroids |
Long-term corticosteroid use can cause side effects like osteoporosis, high blood pressure, and muscle weakness.
To help manage these risks, doctors may recommend calcium, vitamin D, and medications (such as bisphosphonates). Regular checkups help monitor complications and allow doctors to adjust treatment if necessary.
Doctors may prescribe tocilizumab as injections under the skin for some people. Because it can increase the chance of infections, doctors monitor patients carefully.
Managing Everyday Health at Home
Healthy daily habits can help people with giant cell arteritis feel better and protect their long-term health. Balanced nutrition is especially important, as it may help lower the risk of osteoporosis, high blood pressure, and diabetes.
| Health Tip | Benefit |
|---|---|
| Nutritious diet | Bone, blood pressure, diabetes |
| Enough calcium & vitamin D | Bone strength |
| Regular exercise | Weight, mood, bone, blood pressure |
| Routine doctor visits | Monitor side effects, early action |
| Ask about low-dose aspirin | May help prevent complications |
Focusing on fresh fruits and vegetables, whole grains, and lean proteins such as fish or poultry can support stronger bones and general well-being. Salt, sugar, and alcohol should be limited to help manage blood pressure and prevent other side effects.
Calcium and vitamin D are essential, especially for women over 50 and men over 70, as they help keep bones strong and reduce the risk of osteoporosis.
The recommended daily intake is about 1,200 mg of calcium and 800 IU of vitamin D. Checking with a healthcare provider can help determine the right amount for each person.
Regular physical activity, like walking or light exercise, helps maintain bone density and supports a healthy weight. It can also lower the chances of heart, lung, and blood pressure problems.
Even those new to exercise can start slowly and build up over time.
Monitoring health through regular medical visits is key. These visits check for medication side effects, like weight gain, loss of appetite, or blood sugar changes, especially in seniors, Caucasians, or those experiencing unexplained weight loss.
Some may also benefit from low-dose aspirin to reduce the risk of vision problems or stroke, but any new medication should be discussed with a doctor.
Tips for Managing and Finding Help
Staying informed about giant cell arteritis and its treatments can help people feel more secure with their care. They should talk with their medical team to address any worries.
Being aware of signs of related conditions such as glaucoma or cataracts is important, especially as people age.
- Join support groups to connect with others.
- Watch for medication side effects.
- Report health changes to your doctor.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Before the appointment, make a to-do list:
- Find out if any special rules apply before your visit, like fasting before blood tests.
- Write down all the symptoms you have noticed, such as headache, scalp tenderness, jaw pain, fever, muscle weakness, neck stiffness, fatigue, dizziness, or problems in your arms. Note when these started and any changes you have seen.
- Track any risk factors or recent changes in your medical history, such as new health conditions or major life events.
- List all medicines, vitamins, and supplements you use, including the amount and how often you take them.
- Prepare a list of questions for your doctor. Some examples can include:
- What could be causing my headaches or other symptoms?
- What tests do you recommend, and why?
- What treatments are available, and what side effects should I expect?
- How long will I need to take medications?
- Can giant cell arteritis happen again?
- What impact will this have on my daily life or other health conditions?
- Should I adjust my diet or supplements?
It can help to have a friend or family member join you. They might remember details you miss or help you with notes.
Questions Your Healthcare Provider Might Ask
During the visit, the doctor will likely ask questions to learn more about your symptoms. They may ask things like:
- Are your symptoms steady or do they come and go?
- How strong are your headaches, jaw pain, or other symptoms?
- What have you noticed that makes your symptoms better or worse?
- Have you had changes in vision, muscle weakness, or scalp pain?
Being ready to answer these questions can make your visit go smoother.
How to Manage While You Wait
While waiting for your appointment, ask if you can take over-the-counter pain relievers, such as acetaminophen, ibuprofen, or naproxen, to help with headache or scalp tenderness.
Track new or worsening symptoms, including eye changes, fatigue, neck pain, or jaw discomfort. If vision problems appear or get worse, contact an eye specialist (ophthalmologist) quickly.
Bring all notes, lists, and questions to your visit to make the most of your appointment.
