Temporal (Giant Cell) Arteritis

Temporary Vision loss? Throbbing Headache? Jaw pain? Female? You could have Temporal (Giant Cell) Arteritis. It affects those arteries traveling to your temples (these are in front of your ears going up the
scalp) – hence, Temporal Arteritis. It is the most common disease affecting large vessels of the heart in ages >50 years old. It usually affects females. A little anatomy is necessary to better understand which blood vessel is becoming granulomatous, in other words inflamed. See picture below (branches of the carotid artery). Important to note, 50% of patients with Giant Cell Arteritis also have Polymyalgia Rheumatica – associated with pain and stiffness in the neck, shoulders or hips.

What it feels like:

Persistent, severe head pain, usually in your temple area
• Scalp tenderness
• Jaw pain when you chew or open your mouth wide
• Fever
• Fatigue
• Unintended weight loss
• Vision loss or double vision, particularly in people who also have jaw pain
• Sudden, permanent loss of vision in one eye

How is it happening:

• Arteries are the blood vessels that carry blood from the heart to the rest of your body. These arteries are made up of layers of linings and this becomes inflamed and starts to swell. The inner lining of the blood vessel swells up and becomes really narrowed so little blood travels through. When blood cannot cross these narrowed blood vessels, tissues cannot receive nutrients and become painful. We do not know what causes the vessel walls to become irritated, but its thought to be because your own immune system is attacking it.

Will you be affected:

• Does anyone in your family have it?
  If yes, then you could be at risk for Temporal (Giant Cell) Arteritis because sometimes it runs in
  the family

• Are you older than age 50?
  If yes, you may or may not develop the signs and symptoms yet

• Are you Female?
  If yes, you are twice more likely to develop the
  condition

• Are you Northern European or of
  Scandinavian descent?
  If yes, you are among the most common group
  of people to have the condition

• Do you have Polymyalgia Rheumatica?
  if yes, you are at a greater risk of developing
  Temporal (Giant Cell) Arteritis

What is Polymyalgia Rheumatica:Refer to picture above. Patient mostly wake up with muscle pain.
Worst things that could happen:

• Blindness → Sudden, painless vision loss because of less blood going to the eyes
• Aortic Aneurysm → In other words, the blood vessel is so weak and thin that it starts to bulge
  outward – also known as an aneurysm. “Aortic” means this is happening in the Aorta which is
  the largest vessel in the body running down the center of the chest.

• Stroke → Not enough blood travelling to the brain. This is uncommon.

How will Doctors know:
Temporal (Giant cell) Arteritis is sometimes not easy to diagnose because the symptoms resemble other conditions. So, doctors have to rule out other causes like a heart condition you might have that is causing these problems. The doctor will ask about your symptoms, medical history, take a physical exam and pay close attention to the vessels around the temples – looking for tenderness, hardness and a reduced pulse. The doctor may ask you take a different test. Bloodwork, MRA, Doppler ultrasound, and PET scan. However, the best way for doctors to verify that they are dealing with Temporal (Giant cell) Arteritis is by cutting a small part of the temporal artery (a biopsy) and examining it under a microscope in a lab. Sometimes the results are unclear so they may ask for another biopsy.

How to treat it:

1. High doses of Corticosteroid drugs like Prednisone.
2. FDA recently approved Tocilizumab (Actemra) injections.
3. Lifestyle modifications: eat a healthy diet, exercise often, regular doctors’ visitations.
4. Calcium (1200mg) and Vitamin D (800IU) for men over 70 and women over 50.
5. Daily low-dose aspirin (ask doctor about taking 75-150mg).
6. Ask your doctor more questions, this can help you feel more in control of your condition.
7. Report any changes to your doctor! This will help with developing a better treatment plan for
   you

Ask your doctor if these help with pain:

• Acetaminophen (Tylenol, others)
• Ibuprofen (Advil, Motrin IB, others)
• Naproxen sodium (Aleve)

References:
https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758
Image:https://creakyjoints.org/education/what-is-polymyalgia-rheumatica/
Image:https://creakyjoints.org/diagnosis/temporal-artery-biopsy-to-diagnose-giant-cell-arteritis/