This is how we can diagnose and manage Giant cell arteritis

Giant cell arteritis(temporal arteritis) is an autoimmune illness that affects the body’s large arteries, particularly the temporal artery.  The temporal artery is placed on the side of the head, and it becomes irritated for no apparent reason, resulting in blockage, inflammation, and prominence of the temporal artery beneath the skin.Females over the age of 60 are the most typically affected by this disease, for no apparent cause. 

 

 

Symptoms of Giant cell arteritis

The clinical manifestations are as follows:

·      Patients typically report a sudden or slow-growing headache for days or weeks. The intensity of a headache is severe, and it occurs frequently.

·      When chewing food or talking, jaw pain can occur.(jaw claudication)

·      Inflamed vessels beneath the epidermis make the scalp tender and painful to touch.

·      Visual problems, this may include acute loss of vision. There are also other unusual symptoms patients may present with;

·      Flu like illness or persistent fever

·      Continuous cough

·      Depression

·      Exhaustion

·      Loss of appetite

·      Lack of energy

·      Sleep deprivation

·      Weight reduction that is unexpected.

 

 

Diagnosis of giant cell arteritis

 

Initially, Some blood tests to detect the intensity of inflammations are usually requested for this type of patient such as CRP and ESR .In this case, an increased ESR value is a critical and sensitive. Regardless of the results of the temporal artery biopsy, if it is more than 40mm/hr, your doctor should start steroids right once to avoid the most catastrophic consequence like loss of vision.

 If its suspicion has been established then temporal artery biopsy is performed to conform the diagnosis, which involves the removal of a part of this artery under the effect of local anaesthetic injection and then this sample is examined under the microscope to detect the pathological granulomatous inflammatory changes in the temporal artery if any. In some patients the biopsy report comes normal but this does not rule out the condition.

  As it is a day care procedure, there is no need to stay in hospital for long. Your doctor will prescribe you with some simple painkillers and topical antibiotic cream to apply on the wound to avoid any further complication. Following the removal of the dressing, you can resume typical activities such as driving and working. To avoid wound infection, you should avoid going in the dirt or in an open area.

 

Temporal artey biopsy

 

Liver function tests usually indicate a higher level of serum alkaline phosphatase, which is of no use in confirming the diagnosis.

Cranial ultrasound that is a new way to investigate this disease but further research needed for this.

Magnetic resonance angiography

CT angiography

PET scanning

 

 

Treatment of Giant cell arteritis

 

High doses of steroids, such as prednisolone, are used to treat this condition due to their anti-inflammatory properties.

The treatment is provided in two stages to the patients.

The first step of treatment comprises a very high dose of steroids orally for weeks or months, after which it is gradually decreased to the lowest feasible maintenance dose of steroid under the supervision of a medical doctor in the second phase of treatment. This treatment lasts for almost three years.

However, in the case of sight loss, the treatment could be different, such as injectable steroids to alleviate the problem as much as possible.

Even if this arteritis isn't diagnosed yet, your doctor will start you on steroids to prevent disease complications. You'll also be told to take low-dose aspirin on a daily basis to prevent inflammation and complete blockage of other arteries in your head and neck, which could lead to a catastrophic condition like stroke.

 

When you use steroids, you're more likely to get stomach ulcers. Your doctor prescribes proton pump inhibitors to protect your stomach. Try not to use other anti-inflammatory drugs without doctor’s advice because their use may lead to stomach ulcers more rapidly.

 

Other drugs known as bisphosphonates are frequently recommended to prevent bone weakening, which is a side effect of steroid treatment.

 

You've probably figured out that this is an inflammatory condition in which your immune system becomes overly reactive to your own body tissues, producing substances like interleukin and causing immune cells to migrate to the site of action. Your doctor may prescribe an immunosuppressant such as methotrexate to prevent the disease from recurring and to keep you free of symptoms for long time.

 

Side effects of taking steroids 

 

There is a chance that you will acquire certain steroid-related side effects if you use steroids.

We'll try to sketch down some of them in case you come up with any of them, as well as some solutions to go along with them.

 

High blood sugar

These medications can cause blood sugar levels to rise, which can lead to diabetes. For that, try to keep an eye on your carbohydrate and sugar intake.

 

High blood pressure

As a result of the increased volume burden on your body, you may develop hypertension. Regular exercise can be beneficial to combat this issue.

 

Osteoporosis and avascular necrosis of bones

 Patients who take a larger dose of steroids are more likely to develop osteoporosis, which is characterised by bone weakening. It could indicate that your bone mineral density is low, making you more susceptible to fractures.

Special types of drugs, such as bisphosphonates, are normally recommended to be used on a regular basis to avoid this. Your doctor may also encourage you to consume more dairy products, such as milk and cheese.

To maintain bone health, you will also be encouraged to take supplements such as vitamin D and calcium-containing pills.

Avascular necrosis of the bones is an uncommon complication that can arise as a result of steroid treatment. The blood supply to the affected bone or joint will be entirely cut off. Same dietary changes are recommended.

 

Diet recommendation for osteoprosis

 

Weight gain

Another issue you may encounter is weight gain. To address these problems, a low-calorie diet, moderate exercise, and adequate water consumption are required.

Low mood and disturbed sleep

You should expect mood swings, such as feeling depressed, irritated, or energised at times. It's also possible that this will disrupt your sleep.

If you're having any of these issues, talk to your doctor.

 

Eye problems

If you use more than 25mg of high-dose steroids per day, you are at risk of developing cataracts and glaucoma.  If any of these are bothering you, make an appointment with your ophthalmologist. They may conduct some ocular tests to ensure that you are in good health.

Because every adverse effect does not occur in every individual, the benefits of taking steroids and their negative effects should be carefully discussed and weighed with your healthcare professional.

In addition, side effects are affected by other factors too such as the length of time you've been taking drugs and the dose you're taking.

 

Side effects of steroids

 

 

Complications of giant cell arteritis

 Polymyalgia rheumatica and aortic aneurysm can affect up to two-thirds of patients with giant cell arteritis. Aortic aneurysm is an abnormal dilation of the body's main blood vessel, the aorta, which can rupture as a result of the inflammatory insult and cause mortality.

This disease can affect the heart and other essential organs, such as the brain, resulting in a myocardial infarction or stroke.

 

Polymyalgia rheumatica