HMU\ College of Dentistry

GIANT CELL ARTERITIS

WRYA NASRADIN
CONTENTS:-

 Definition
 Symptoms
 Cause
 Pathogenesis
 Risk facors
 Complications
 Diagnosis
 Treatment
 Life style and home remedies
Some specific types of vasculitis are:
 Behcet's disease
 Buerger's disease
 Central nervous system (CNS) vasculitis
 Churg-Strauss syndrome
 Cryoglobulinemia
 Giant cell arteritis
 Henoch-Schönlein purpura
 Kawasaki disease
 Takayasu's arteritis
 Wegener's granulomatosis
 Rapidly progressive glomerulonephritis
The term “giant cell arteritis” is often used
because when one looks at biopsies of
inflamed temporal arteries under a microscope,
one often sees large or “giant” cells.
 GIANT CELL ARTHRITIS

 Giant cell arteritis, or GCA, is one of a group of

conditions referred to as vasculitis, meaning inflammation
in the blood vessels.

  In GCA, the vessels most often involved are the arteries
of the scalp and head, especially the arteries over the
temples, which is why another term for GCA is “temporal
arteritis.
 GCA can overlap with polymyalgia rheumatica
(PMR). At some point, 5 – 15% of patients with
PMR will have a diagnosis of GCA. About 50 percent
of patients with GCA have symptoms of PMR.

 The two conditions may occur at the same time or on

their own. It also affects the same types of patients as
does PMR.

 In an older adult, a new, persisting headache -

especially if together with flu-like symptoms,
unexplained fatigue (tiredness) or fevers - can be due
to giant cell arteritis.
SIGNS AND SYMPTOMS
 New headache, usually around the temples

 Fatigue

 Loss of appetite
 Weight loss

 Flu-like feeling.

 Pain in the jaw with chewing.

 Sometimes the only sign of GCA is unexplained fever.

 pains in the face, tongue, or throat.

 Pain and stiffness in the neck, shoulders or hips are common
symptoms of a related disorder, polymyalgia rheumatica.

 If GCA spreads to the blood supply of the eye, eyesight can be

affected. Problems with vision can include temporary blurring,
double vision or blindness.

 Permanent loss of vision in GCA can occur suddenly, but proper

treatment can prevent this complication.

 Less commonly, GCA can affect other large blood vessels that
could lead to pain when using the arm muscles or in the calves
when walking.

 Occasionally, GCA can cause strokes or mini-strokes (also known

as transient ischaemic attacks or TIAs).
CAUSE

 We don’t know the exact cause of GCA yet. However,

we do know that it’s an autoimmune condition.
PATHOGENESIS
 With giant cell arteritis, the lining of arteries
becomes inflamed, causing them to swell. This
swelling narrows your blood vessels, reducing the
amount of blood and, therefore, oxygen and vital
nutrients that reaches your body's tissues.
 Risk factors
 Age. Giant cell arteritis affects adults only, and rarely
those under 50. Most people with this condition develop
signs and symptoms between the ages of 70 and 80.
 Sex. Women are about two times more likely to develop
the condition than men are.
 Race and geographic region. Giant cell arteritis is most
common among white people in Northern European
populations or of Scandinavian descent.
 Polymyalgia rheumatica. Having polymyalgia rheumatica
puts you at increased risk of developing giant cell
arteritis.
 Family history. Sometimes the condition runs in families.
 Complications
 Blindness. Diminished blood flow to your eyes can
cause sudden, painless vision loss in one or, rarely, both
eyes. Loss of vision is usually permanent.

 Aortic aneurysm. This complication can occur even

years after the diagnosis of giant cell arteritis

 Stroke. This is an uncommon complication of giant cell

arteritis.
Diagnosis
 A diagnosis of giant cell arteritis (GCA) is based on:

1. Signs & Symptoms

2. Clinical examination
3. Blood tests
4. Temporal artery biopsy
5. Imaging Tests

 Giant cell arteritis can be difficult to diagnose because

its early symptoms resemble those of other common
conditions.
Blood Tests
 Used to check for signs of inflammation in the
blood vessels.

 Erythrocyte sedimentation rate (ESR)

 C-reactive protein (CRP)

 In most cases, ESR and CRP are high in people

who have GCA. However, a normal result doesn't
necessarily rule out GCA, and inflammation may
have other causes such as infection.
Imaging Tests
 These might be used to diagnose giant cell arteritis and
to monitor your response to treatment. Tests might
include:

 Doppler Ultrasound. 

 Magnetic resonance angiography (MRA). 

 Positron emission tomography (PET). 

 Biopsy
 The best way to confirm a diagnosis of giant cell
arteritis is by taking a small sample (biopsy) of the
temporal artery.

 If you have giant cell arteritis, the artery will often show
inflammation that includes abnormally large cells, called
giant cells. It's possible to have giant cell arteritis and
have a negative biopsy result.
 Treatment
 The treatment for GCA should begin as soon as possible because
of the risk of loss of vision.
 If you have visual loss before starting treatment with
corticosteroids, it's unlikely that your vision will improve.
However, your unaffected eye might be able to compensate for
some of the visual changes.
 If your doctor strongly suspects GCA, treatment can start before
you get the results of a temporal artery biopsy.

 Unlike the treatment for PMR, which requires only low-dose

corticosteroids, GCA treatment usually involves high doses of
corticosteroids.
 Typically, the dose is 40-60 mg per day of prednisone
 The high dose of corticosteroids usually continues for a
month, and then the dose is slowly decreased.

 In most cases, though, the prednisone dose can be

reduced to about 5 – 10 mg per day over a few
months. Patients are usually tapered off this medicine by
one to two years.

 GCA rarely returns after treatment.

 Headaches and other symptoms quickly decrease with

treatment, and the sedimentation rate declines to a
normal range.
 Pleasurable News Unpleasurable News
 Actemra (tocilizumab) was approved 2017 by the FDA to treat
adults with giant cell arteritis. It's given as an injection under your
skin. Side effects include making you more prone to infections.

 Corticosteroids can lead to serious side effects, such as

osteoporosis, high blood pressure and muscle
weakness.

 To counter potential side effects, your doctor is likely to

monitor your bone density and might prescribe calcium and
vitamin D supplements or other medications to help prevent
bone loss.
 Other treatments

 Steroids are the best first-line treatment available to get GCA

under control quickly.

 However, if you have a relapse your doctor may suggest an

additional medication to help reduce the dose of steroids. For
example, a disease-modifying anti-rheumatic drug (DMARD)
 such as methotrexate, leflunomide or azathioprine.

 Your doctor may suggest low-strength aspirin (75 mg) as it

helps to protect against loss of vision. Aspirin has been shown to
have effects on the immune‐mediated inflammation in GCA,
hence it may reduce damage caused in the arterial wall.
 Calcium and vitamin D supplement to protect your
bones.

 Bisphosphonate to reduce the risk of developing

osteoporosis.

 Because steroids can affect the stomach lining, you

may also be given a stomach-protecting tablet (for
example,PPI) such as omeprazole.

 Bisphosphonates and PPIs will usually be started at the

same time as the steroids.
 Lifestyle and home remedies
 When giant cell arteritis is diagnosed and treated
early, the prognosis is usually excellent.

 Get checkups. See your doctor regularly to check for

side effects of treatment and development of
complications.
 Eat a healthy diet. Eating well can help prevent potential
problems, such as thinning bones, high blood pressure
and diabetes. Emphasize fresh fruits and vegetables,
whole grains, and lean meats and fish, while limiting
salt, sugar and alcohol.

 Exercise regularly. Regular aerobic exercise, such as

walking, can help prevent bone loss, high blood
pressure and diabetes. It also benefits your heart and
lungs.
 Is giant cell arteritis serious?
-YES, Blindness
 Can giant cell arteritis be cured?
-Treatable, controllable, and often curable disease
 Is giant cell arteritis fatal?
-Death is rare, A case of fatal GCA is reported in a woman with a
normal erythrocyte sedimentation rate, who had been treated for
temporal arteritis for eight months.
 Can giant cell arteritis go away on its own?
-No
 Does giant cell arteritis run in families?
-May run in families.
 Is giant cell arteritis an autoimmune disease?
-not fully understood, although it is thought to be an autoimmune
disease
REFFERENCE
 Giant Cell Arteritis (no date). Available at:
https://www.rheumatology.org/I-Am-A/Patient-
Caregiver/Diseases-Conditions/Giant-Cell-Arteritis (Accessed:
20 April 2019).

 Giant cell arteritis - Symptoms and causes (no date) Mayo

Clinic. Available at: https://www.mayoclinic.org/diseases-
conditions/giant-cell-arteritis/symptoms-causes/syc-20372758
(Accessed: 20 April 2019).