Giant cell arteritis (GCA), also known as temporal arteritis, is an inflammatory condition primarily affecting the lining of large and medium-sized arteries. This inflammation can cause a narrowing or blockage of these blood vessels, interrupting normal blood flow. While GCA can affect arteries throughout the body, it commonly involves those in the head and neck, such as the temporal arteries. Though treatable, GCA carries a risk of serious complications from artery damage.
Vision Impairment
GCA can affect vision by damaging arteries supplying blood to the eyes and optic nerve. When inflammation narrows or blocks these vessels, the optic nerve may not receive enough blood flow, a condition known as anterior ischemic optic neuropathy (AION). This lack of blood supply can lead to various visual disturbances.
Individuals may experience temporary vision changes, such as fleeting episodes of blurred vision or a sensation of a curtain passing over their eye, medically termed amaurosis fugax. Permanent vision loss is a risk, which can occur suddenly and is often irreversible. This severe outcome can affect one or both eyes.
Brain and Nervous System Events
GCA can lead to cerebrovascular complications when inflammation affects arteries supplying the brain. These complications include ischemic strokes and transient ischemic attacks (TIAs). Ischemic strokes occur when blood flow to a part of the brain is blocked, leading to brain cell damage.
TIAs, often called “mini-strokes,” involve a temporary disruption of blood flow to the brain, producing stroke-like symptoms that resolve quickly. Symptoms can include sudden weakness or numbness on one side of the body, difficulty with speech, or problems with balance and coordination. Less common neurological issues like peripheral neuropathy may also be observed if directly related to the arterial inflammation.
Aortic and Major Artery Issues
Beyond the head and neck, GCA carries a long-term risk of affecting the aorta and other large arteries. Inflammation can weaken artery walls, leading to aortic aneurysms. An aneurysm is a bulge that forms in a weakened section of the artery, often in the large artery running down the chest and abdomen.
Less commonly, GCA can cause aortic dissection, a tear in the inner layer of the artery wall. These major artery issues can manifest years after initial GCA diagnosis, even when the disease appears controlled. The potential for rupture is a life-threatening event requiring immediate medical intervention.
Reducing the Risk of Complications
Early diagnosis and prompt treatment are essential to minimize GCA complications. High-dose corticosteroids, such as prednisone, are the primary treatment to rapidly control inflammation and protect arteries from further damage. This initial therapy aims to suppress the inflammatory process and prevent irreversible damage, particularly to vision.
Ongoing monitoring and regular follow-up appointments are necessary to assess disease activity and adjust treatment. This may include periodic imaging of the aorta to detect developing aneurysms or other arterial changes. Other medications, such as tocilizumab, an immunosuppressant, may be used alongside or to reduce reliance on corticosteroids, especially when steroid side effects are significant or the disease is difficult to control. Adherence to the prescribed treatment regimen and regular medical check-ups are fundamental steps in mitigating severe GCA outcomes.