At a glance
What it is
Giant cell arteritis (GCA), also called temporal arteritis, is a systemic vasculitis characterised by granulomatous inflammation of the walls of medium and large arteries — predominantly the superficial temporal, ophthalmic, posterior ciliary, and branches of the carotid and aorta. It affects almost exclusively adults over 50 (peak incidence 70–80 years). The inflamed vessel walls thicken and may occlude, leading to tissue ischaemia. The most feared complication is permanent visual loss from anterior ischaemic optic neuropathy.
Symptoms
New-onset, severe temporal headache — usually unilateral or bilateral, persistent, and often described as boring or throbbing. Scalp tenderness (combing hair is painful; temporal artery may feel nodular and non-pulsatile on examination). Jaw claudication — pain and fatigue on chewing, relieved by rest: a highly specific symptom. Visual disturbances: amaurosis fugax (transient loss of vision in one eye), diplopia, or sudden permanent visual loss in one or both eyes. Constitutional symptoms: fever, malaise, fatigue, and unintentional weight loss. Neck and shoulder girdle stiffness suggests coexisting polymyalgia rheumatica. Elevated ESR (often > 100 mm/hr) and CRP are characteristic.
Approach
GCA is a medical emergency when visual symptoms are present. High-dose prednisolone (40–60 mg/day, or 1 g IV methylprednisolone daily for 3 days if visual loss has already occurred) is started immediately — before biopsy results are available. Temporal artery biopsy (the gold standard) confirms the diagnosis but must not delay treatment. Tocilizumab (IL-6 inhibitor) is now approved as a steroid-sparing agent, reducing relapse rates and total steroid burden. Steroids are tapered over 1–2 years guided by symptoms and inflammatory markers. Annual imaging of the aorta screens for late aortic aneurysm.
What temporal arteritis is
Giant cell arteritis is the most common form of systemic vasculitis in adults over 50. The name "temporal arteritis" reflects its predilection for the superficial temporal arteries, but GCA is a systemic disease affecting medium and large arteries throughout the body — including the aorta and its major branches.
**Pathophysiology**
Activated CD4+ T cells and macrophages infiltrate the arterial wall at the adventitia-media junction, forming granulomas containing multinucleated giant cells. Intimal hyperplasia narrows and may occlude the arterial lumen. In affected vessels, blood flow is reduced — in the ophthalmic and posterior ciliary arteries, this can lead to ischaemia of the optic nerve head (anterior ischaemic optic neuropathy), producing sudden, painless, permanent visual loss.
**Relationship with polymyalgia rheumatica (PMR)**
Polymyalgia rheumatica — bilateral aching and morning stiffness in the shoulder and hip girdles in patients over 50 — is present in approximately 50% of GCA patients. Conversely, about 15–20% of PMR patients have GCA. The two conditions share the same underlying inflammatory process. PMR responds to low-dose prednisolone (15–20 mg/day), which is insufficient to treat GCA; GCA always requires higher doses.
**Diagnosis**
The ACR classification criteria incorporate age ≥ 50, new headache, abnormal temporal artery on examination, elevated ESR, and biopsy findings. Temporal artery ultrasound (showing the "halo sign" from oedematous vessel walls) is increasingly used as a non-invasive alternative to biopsy, especially when bilateral and with high sensitivity. Temporal artery biopsy remains the gold standard, but a negative biopsy does not exclude GCA if clinical features are compelling.
**Treatment and monitoring**
*Corticosteroids* are the cornerstone — initiated immediately when GCA is suspected. Doses are gradually reduced over 1–2 years, but relapse is common; monitoring of symptoms, ESR, and CRP guides tapering. Side effects of prolonged corticosteroid use (osteoporosis, diabetes, hypertension, cataracts) require prophylaxis and monitoring.
*Tocilizumab* (subcutaneous, weekly or fortnightly) is approved as an adjunct, allowing faster steroid tapering and significantly reducing the relapse rate.
*Aortic surveillance* — GCA carries a lifetime risk of aortic aneurysm (especially thoracic aortic aneurysm) that may manifest years after the initial diagnosis. Annual chest imaging and periodic CT/ultrasound surveillance are recommended.
Treatment options at Alimran Medical Center
Injection therapies
- Botox® injections
- Prolotherapy
- Ozone injection
- Trigger point injections
- Epidural steroid injections
Advanced therapies
Physiotherapy & rehabilitation
- Electrical stimulation
- Short and long wave therapy
- Laser therapy
- Ultrasound therapy
- Shoulder and hip girdle rehabilitation
- SpineMED® system
- Sigma
Book a consultation
The secretary schedules first appointments during clinic hours; please have prior imaging, operative notes and a current medication list available at the time of the call.
This page provides general information about temporal arteritis and is not a substitute for individual medical assessment. If your symptoms are severe or worsening, contact a clinician promptly.