You feel like you are coming down with something. After a few days, you begin to get stiffness and aches in your neck and shoulders; your mouth and jaw hurt; and you have a slight fever. By the time you call a doctor, you are suffering from splitting headaches so bad that they are affecting your vision.
A bad case of the flu? Probably. But these symptoms can also be the classic warning signs of a little-known but not so rare disease called Giant Cell Arteritis (GCA).
If detected early enough, Giant Cell Arteritis is, if anything, more treatable than the flu. Left untreated, however, Giant Cell Arteritis can make you permanently blind.
Doctors do not know what causes GCA or how it chooses its victims. GCA seems to be related, but we're not sure how, to another disease called Polymyalgia Rheumatica, which has similar symptoms and for which it is frequently mistaken. (Polymyalgia Rheumatica may last longer than Giant Cell Arteritis, but it does not cause blindness). Thankfully, doctors do know how to treat both diseases.
If detected early enough, Giant Cell Arteritis is, if anything, more treatable than the flu.
What is Giant Cell Arteritis?
Also known as temporal arteritis and cranial arteritis, Giant Cell Arteritis is an inflammatory disorder that causes inflammation and swelling in the arteries of the head, neck and arms. This swelling narrows affected arteries, reducing blood flow. The inflammation seems to be triggered by some kind of infection or other outside cause. While we do not know what this cause may be, some researchers have theorized that it may have something to do with ultraviolet (UV) light damage to the blood vessels around the retina, the light-sensitive part of our eyes. It is this swelling that can reduce or cut off blood flow to the eye area and lead to blindness.
Who gets GCA?
Giant cell arteritis occurs exclusively in people who are 50 or older and it becomes more common with age. The average age of GCA victims is 70. It is uncommon in African-Americans, but slightly more common among women and fair-skinned people of northern European extraction.
Just a Headache?
Headache is the most common symptom of Giant Cell Arteritis. This is unfortunate because headaches are so common, with many causes, from simple tension to sinusitis to migraine, that your doctor would not normally suspect Giant Cell Arteritis. When your headache is accompanied by other signs of Giant Cell Arteritis, however, telling you to go home, rest and take two aspirin can have devastating consequences.
The Signs and Symptoms of GCA
- Headaches caused by Giant Cell Arteritis occur on one side of the head. The pain is often described as sharp or burning, not throbbing. There may be visible swelling and redness in the same area as the pain. People with Giant Cell Arteritis normally recognize this headache as something very different from headaches caused by tension, sinusitis, migraine or other common causes.
- Sudden blindness in one eye is a symptom that occurs very early on. When this happens, there is no time to lose. If this is treated with high doses of intravenous steroids within 24 hours, there is a small chance that vision can be saved in the affected eye and a very good chance that the disease will be prevented from attacking the second eye.
- Double vision is a clear warning sign of impending blindness.
- Jaw claudication, or pain while chewing, is a very important symptom because it occurs early on and is an even earlier warning sign of impending blindness.
- The presence of dark patches of skin above the temples. This is a sign that the skin in this area has begun to die from lack of a blood supply.
Confirming the Diagnosis
A doctor who sees some of these symptoms should suspect Giant Cell Arteritis and order a special blood test that measures the so-called erythrocyte (red blood cell) sedimentation rate (ESR). The ESR is greatly elevated in 95% of patients with Giant Cell Arteritis and is, therefore, very useful in confirming a clinical suspicion of this disease. However, many diseases besides Giant Cell Arteritis can cause an elevated ESR and so your doctor may want to confirm the diagnosis by performing a biopsy of the temporal artery, which is frequently affected by the disease. The temporal arteries are situated just below the skin of the temples and the biopsy procedure is almost risk free. The biopsy is studied by a pathologist under a microsope looking for inflammation and especially for very large inflammatory cells called "giant cells." It is these cells that are the basis for the disease's name.
Anyone who is suspected of having Giant Cell Arteritis should not wait for a blood test or a biopsy. They should be started on a steroid such as prednisone right away. Steroid treatments usually last for at least three weeks before being tapered off.
Prednisone is a powerful steroid. Steroids can cause many side effects, especially in high doses. Some of these to watch out for or to consider are:
People taking steroids may have all, some or none of these side effects. Because prednisone and other steroids affect the body's natural hormone production, the dosage must be gradually tapered off and you should not stop taking the medication unless told to do so by your doctor.
- fluid retention and weight gain
- swelling of the face
- wounds that heal slowly
- easy bruising
- high blood pressure
- decreased calcium absorption in the bones, which can lead to osteoporosis
- irritation of the stomach
Giant Cell Arteritis is a very serious condition affecting seniors that can usually be diagnosed and tr eated successfully with the steroid prednisone. Because many of its symptoms are so similar to those of the flu and other relatively mild illnesses, however, it is fairly easy to miss. If the subtle warning signs of Giant Cell Arteritis are missed, blindness may result.