Giant Cell Arteritis (Temporal Arteritis)

What is GCA?

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

Symptoms of recurrence

As your doctor gradually reduces your dose of steroids, 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.

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

    If you develop a new headache or 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 these are not the same steroids taken by bodybuilders. There are some side effects of steroids to be aware of—see the 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 under local anaesthetic to remove a small sample of artery from the scalp over the temple.

    Follow-up

    If the diagnosis of GCA is confirmed, you will be followed up in the rheumatology clinic. You will need several follow-up appointments with your rheumatologist to monitor symptoms as they gradually reduce your steroid dose. You should keep taking the prescribed steroid dose 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 the 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. To protect your bones, your doctor may recommend a combination of lifestyle and medication changes:

    • Regular physical activity such as walking
    • Stopping 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, raising your risk of developing diabetes, so you should ensure you eat a healthy diet.

    While on steroids, you should carry a steroid card at all times. This alerts doctors that you require steroids should you become unwell and need 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

    While on steroid treatment, you should take care not to have certain vaccines (without first speaking to your doctor) such as: 

    • Shingles
    • Yellow fever
    • Chickenpox

    You should contact your doctor if you have not had chickenpox 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 vaccines if desired. Steroid use can affect your ability to fight infections so getting vaccinated against flu and COVID-19 is especially important.

    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