Information for people who have, or are under investigation as potentially having, giant cell arteritis (GCA)

What is Giant Cell arteritis?

Your doctor suspects you may have a condition called Giant Cell arteritis (GCA), which is sometimes referred to as ‘temporal arteritis’. This is an inflammatory condition that mainly affects medium and large blood vessels of the head, neck and sometimes chest. The condition is one of the most common types of inflammation of the arteries and veins (vasculitis). Symptoms suggestive of giant cell arteritis include:

• headache / scalp sensitivity
• change in vision
• achy pains on chewing/eating

These can often develop suddenly, but may follow vague symptoms such as weight loss and prolonged tiredness. GCA is often linked to a condition called polymyalgia rheumatica (PMR), which causes pain and stiffness of the muscles particularly in the shoulders, neck, hips and thighs. Often people have both PMR and GCA.

Who is affected by GCA?

In the UK, it's estimated about 1 in every 4,500 people will develop giant cell arteritis each year. It is is very rare in people younger than 50, and those who develop the condition are usually over 60 years of age. Giant cell arteritis is three times more common in women than in men.

Diagnosis and treatment

Treatment for GCA will usually begin as soon as possible. This may mean that treatment begins before a diagnosis is confirmed. Treatment should not be stopped unless advised by your doctor.

The main treatment for giant cell arteritis is steroid medication. Most people need to take steroids on a long-term basis to prevent their symptoms returning. A two-year course of steroids is usually required. You will be advised by your doctor on the dose to take and how to gradually reduce the dose.

Other medications are taken alongside steroids to reduce the risk of side effects. You will usually be advised to take medication to reduce stomach acid (e.g. omeprazole 20mg daily). Medications to protect your bones are mandatorily prescribed at the same time you start steroids (e.g., alendronic acid 70mg or risedronate 35mg tablet taken once a week) and calcium+vitamin D (supplement) tablets on the other 6 days of the week.

The most effective way to diagnose GCA is to remove some tissue from your temporal artery so it can be studied. This procedure is known as a temporal artery biopsy. If you have been advised to have a biopsy of the artery you should expect to receive an appointment within the first 2-3 weeks following the decision to investigate for GCA. The biopsy is done as a day-case in the Department of Oral and Maxillofacial Surgery at Addenbrooke’s Hospital.

What does the biopsy procedure involve?

The procedure will be carried out under local anaesthetic, which involves an injection in the skin adjacent to the artery.

The sample of artery will be taken from whichever side is causing the more severe symptoms. The artery will be detected with the use of doppler ultrasound prior to the local anaesthetic being administered.

During the procedure you may feel some pushing and pressure but it should not be painful. Once the artery is found a small section of it will be removed and sent for histopathological examination. Both cut ends of the artery are then secured to prevent bleeding. Sutures will be placed to close the wound and an antibacterial ointment applied to the wound. You should not require a dressing.

What should I expect after the procedure?

You may experience some mild pain, which can be easily controlled with simple pain relief such as Paracetamol or Ibuprofen (if tolerated). It is normal to have some temporary bruising, tenderness or numbness around your incision site. This should resolve after several days. Try to avoid getting the area wet after the procedure. Take care not to scratch or disrupt the stitches around the temple area.

Sutures will be placed, which will either be a dissolvable type or require removal, depending on the decision of the surgeon. If removal is required, it will be carried out by the practice nurse at your local GP surgery five to seven days after your procedure. You will not require any further appointments with the Oral and Maxillofacial team.

Will I need further appointments?

Yes. The results of the biopsy will be sent to your treatment team (either Ophthalmology or Rheumatology or the Vasculitis Team) who will then review you with regards to your further management. You will be offered a clinic appointment to review the results of your tests, assess your response to treatment and to make further arrangements for the management of your condition.

Who is in charge of my care?

This letter provides you with contact details for the team who are co-ordinating your care. Please keep it as reference.

The Consultant in charge of your care is .......................................................................................

from the Ophthalmology / Rheumatology / Vasculitis * department at Addenbrooke’s Hospital (*delete as appropriate).

Contact your GP if you have any of the following:

• Change in vision (see ‘In case of emergency’ section below)
• Discharge or bleeding from the wound site
• You are taking regular pain relief and are still in pain.
• Your symptoms worsen

Your GP may get in touch with a member of the department in charge of your care via the hospital switchboard.

Where can I find out more about GCA and its treatment?

An information leaflet which explains in detail about GCA and its treatment is available online (opens in a new tab) by searching the Versus Arthritis website;

If you are unable to access the information leaflet online, please ask a member of your treatment team for a paper copy.