Why Is Giant Cell Arteritis a Medical Emergency?

New-onset giant cell arteritis is considered a medical emergency because inflammation of the arteries can significantly reduce blood flow to vital organs and tissues. Without prompt treatment, the condition can lead to serious complications, including permanent vision loss (blindness) and stroke.

Early diagnosis and aggressive treatment are essential to control inflammation, prevent further damage to the arterial walls and maintain an adequate blood supply to affected organs and tissues.

Treatment should be started as soon as giant cell arteritis is suspected, particularly when there are symptoms involving the eyes. Delaying treatment while waiting for diagnostic test results can increase the risk of irreversible complications.

Who Is at Risk of Developing Giant Cell Arteritis?

Giant cell arteritis primarily affects older adults, with the highest incidence occurring in people aged 70 and older. Although less common, the condition can also develop in people in their 50s and 60s. It is extremely rare in individuals under the age of 50.

Women are approximately twice as likely as men to develop giant cell arteritis. The condition is also reported more frequently among people of Northern European ancestry, who appear to have some of the highest rates of the disease.

Association with Polymyalgia Rheumatica (PMR)

Giant cell arteritis is closely associated with another inflammatory rheumatic condition called polymyalgia rheumatica (PMR).

Approximately 40–60% of people with giant cell arteritis also have polymyalgia rheumatica. PMR causes pain and stiffness, particularly in the shoulders, neck and hips.

The two conditions are thought to share similar underlying inflammatory and immune system mechanisms. They can occur together or independently, and some people with PMR may subsequently develop giant cell arteritis.

Giant Cell Arteritis is best diagnosed by a rheumatologist, a type of doctor that specializes in arthritis and autoimmune disease.

To diagnose the condition, doctors will take a careful and complete history and perform a thorough physical examination. Based on this information, they will likely order tests like blood tests, scans, and other types of tests such as a biopsy (tissue sample) to confirm their diagnosis.

Giant cell arteritis is commonly diagnosed and managed by a rheumatologist, a medical specialist who focuses on arthritis, inflammatory conditions and autoimmune diseases. However, because the condition can cause permanent vision loss, urgent assessment and treatment may be initiated by an emergency physician, ophthalmologist or other healthcare professional before a rheumatology consultation takes place.

The diagnostic process begins with a detailed medical history and a thorough physical examination. Your doctor will assess your symptoms, including headaches, scalp tenderness, jaw pain, visual disturbances and any associated symptoms of polymyalgia rheumatica.

Based on these findings, additional investigations will usually be recommended to support the diagnosis. These may include:

• Blood tests: To look for signs of inflammation and other abnormalities.
• Imaging studies: Ultrasound, MRI, CT or PET scans may be used to identify inflammation in affected arteries.
• Temporal artery biopsy: A small sample of the temporal artery is removed and examined under a microscope for evidence of inflammation.

These investigations help establish the diagnosis, assess the extent of arterial involvement and rule out other conditions that may cause similar symptoms.

Importantly, treatment should begin immediately when giant cell arteritis is strongly suspected. Doctors should not delay starting corticosteroids while waiting for biopsy or imaging results, particularly when there are symptoms suggesting possible involvement of the eyes.

Temporal Artery Biopsy

A temporal artery biopsy is an important diagnostic test used to help confirm giant cell arteritis.

The procedure involves removing a small section of the temporal artery, usually through a minor surgical procedure performed under local anaesthesia. The tissue sample is then examined under a microscope by a pathologist to look for signs of inflammation within the artery wall, including characteristic inflammatory cells known as giant cells.

The presence of inflammation and other characteristic changes in the artery wall can support a diagnosis of giant cell arteritis.

Although temporal artery biopsy is an important diagnostic tool, a negative result does not completely rule out the condition, as inflammation may affect some sections of the artery but not others.

Treatment should not be delayed while waiting for biopsy results if giant cell arteritis is strongly suspected.

Because giant cell arteritis is an inflammatory condition, blood tests are commonly performed to look for evidence of increased inflammation in the body.

Commonly ordered tests include:

• Complete Blood Count (CBC): May reveal abnormalities associated with inflammation, such as anemia or an increased platelet count.
• Erythrocyte Sedimentation Rate (ESR): Measures how quickly red blood cells settle to the bottom of a test tube. An elevated ESR can indicate increased inflammation in the body.
• C-Reactive Protein (CRP): Measures the level of a protein produced by the liver in response to inflammation. Elevated CRP levels can indicate an active inflammatory process.

These tests are useful when investigating suspected giant cell arteritis, but they are not specific to the condition. Abnormal results simply indicate that inflammation may be occurring somewhere in the body and do not establish the underlying cause.

Although ESR and CRP are often elevated in people with giant cell arteritis, normal results do not completely rule out the disease. Blood test findings must therefore be interpreted alongside symptoms, physical examination findings and other diagnostic investigations.

Causes of Giant Cell Arteritis

The exact cause of giant cell arteritis is not fully understood. Researchers continue to investigate the condition to better understand the underlying mechanisms responsible for its development.

What is known is that the immune system becomes abnormally activated in people with giant cell arteritis and other forms of vasculitis. This abnormal immune response causes inflammation within the walls of affected blood vessels, potentially leading to swelling, thickening and reduced blood flow.

One theory is that an environmental trigger, such as an infection, may activate the immune system and cause it to mistakenly attack the body’s own arteries. However, no specific infectious organism has been definitively identified as the cause of giant cell arteritis.

Association with Polymyalgia Rheumatica

Giant cell arteritis is closely associated with another inflammatory rheumatic condition called polymyalgia rheumatica (PMR).

It is estimated that approximately 40–60% of people with giant cell arteritis also have polymyalgia rheumatica, although some studies report higher proportions.

PMR causes pain and stiffness, particularly in the neck, shoulders and hips. These symptoms are typically worse in the morning and may persist for several hours.

The two conditions are believed to share underlying immune system abnormalities and inflammatory pathways. They can occur together or independently, and both are commonly treated with corticosteroid medications.

Giant cell arteritis requires prompt and aggressive treatment to prevent serious complications, particularly permanent vision loss and stroke.

Without effective treatment, inflammation can damage the walls of arteries supplying vital organs and tissues, including the eyes and brain. This can restrict blood flow and lead to potentially irreversible damage.

The primary goal of treatment is to rapidly suppress inflammation, protect the affected blood vessels and prevent further complications.

The course of giant cell arteritis can vary from person to person. Some individuals achieve remission, meaning there is no longer evidence of active disease. In these cases, medication doses may gradually be reduced and, in some instances, eventually discontinued.

For others, giant cell arteritis behaves as a chronic or relapsing condition that requires ongoing treatment to keep inflammation under control and prevent disease recurrence.

Medications for Giant Cell Arteritis

Several medications are available to treat giant cell arteritis. Treatment commonly involves corticosteroids, with additional medications sometimes introduced to improve disease control and reduce the need for prolonged steroid use.

1. Corticosteroids (Prednisone)

Corticosteroids, such as prednisone, are the primary treatment for giant cell arteritis. They work by rapidly suppressing inflammation within the blood vessel walls and helping prevent further arterial damage.

Treatment is usually started with a high dose of prednisone, often around 40–60 mg daily for uncomplicated disease. Higher doses or intravenous corticosteroids may be considered when there is threatened or established visual involvement.

Most people begin to notice an improvement in their symptoms within a few days of starting treatment.

Once symptoms improve and inflammatory markers, such as ESR and CRP, begin to return towards normal, the prednisone dose can gradually be reduced (tapered) under medical supervision.

Although prednisone is highly effective in controlling inflammation, prolonged use can cause significant side effects, including:

• Osteoporosis (bone loss).
• Increased risk of infections.
• Weight gain.
• High blood pressure.
• Elevated blood glucose levels or diabetes.
• Cataracts and glaucoma.
• Muscle weakness.

Because of these potential complications, patients should regularly discuss the risks and benefits of long-term corticosteroid treatment with their rheumatologist.

2. Disease-Modifying Antirheumatic Drugs (Methotrexate)

Disease-modifying antirheumatic drugs (DMARDs) are medications commonly used to treat rheumatoid arthritis and other inflammatory conditions.

Methotrexate is one example that may be used in selected people with giant cell arteritis. It works by modifying immune system activity and can help reduce inflammation.

Unlike prednisone, methotrexate does not work immediately. It may take approximately 6–12 weeks to achieve its full therapeutic effect.

For this reason, patients should continue taking the medication as prescribed, even if they do not notice an immediate improvement.

One of the main benefits of methotrexate is its potential to reduce the amount of prednisone needed to control giant cell arteritis. This is known as a steroid-sparing effect and can help reduce the risk of complications associated with long-term corticosteroid use.

Regular blood monitoring is necessary while taking methotrexate to assess liver function, blood cell counts and potential side effects.

3. Biologic Medications

Biologic medications are a newer class of treatments designed to target specific components of the immune system responsible for inflammation.

One important inflammatory molecule involved in giant cell arteritis is Interleukin-6 (IL-6). This molecule plays a significant role in regulating inflammatory responses.

Research has shown that blocking IL-6 can substantially improve disease control and reduce the need for prolonged corticosteroid treatment.

Tocilizumab (Actemra) is a biologic medication that blocks the IL-6 receptor. It is approved for the treatment of giant cell arteritis and has demonstrated significant benefits in controlling inflammation and reducing the risk of disease relapse.

Tocilizumab can allow many patients to reduce their prednisone dose more quickly, helping minimise the complications associated with long-term steroid use.

Because biologic medications affect immune system activity, patients require appropriate monitoring for infections and other potential adverse effects.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs can help reduce joint inflammation, pain, and stiffness associated with enteropathic arthritis. However, these medications may worsen underlying inflammatory bowel disease (IBD) in some individuals, potentially triggering a flare of bowel symptoms.

Because of this risk, people with enteropathic arthritis should consult their doctor before starting NSAID treatment. A healthcare professional can assess the potential benefits and risks and recommend the most appropriate treatment based on the individual’s joint symptoms and bowel disease activity.

Giant cell arteritis (GCA), also known as temporal arteritis, is an inflammatory condition that affects the walls of arteries. The inflammation causes the arterial walls to become swollen and thickened, narrowing the space inside the blood vessels and potentially restricting blood flow to important organs and tissues.

The condition most commonly affects arteries in the head and neck, particularly the temporal arteries, which run along the sides of the forehead near the temples. This is why the condition is often referred to as temporal arteritis.

Giant cell arteritis belongs to a group of inflammatory diseases known as vasculitis. The term vasculitis literally means inflammation of blood vessels. These conditions occur when inflammation damages the walls of blood vessels, potentially interfering with normal blood circulation.

Although giant cell arteritis most commonly affects the arteries around the head, it can also involve larger blood vessels, including the aorta and its major branches.

Early diagnosis and treatment are particularly important because reduced blood flow to the eyes can result in permanent vision loss.

There is no specific diet proven to stopFibromyalgia.  A Mediterranean-style pattern—vegetables and fruit, whole grains, legumes, nuts, fish, and unsaturated fats—is a reasonable approach for overall health. Foods such as tomatoes and bell peppers can be included, but they shouldn’t be considered treatments for Fibromyalgia.

Tomatoes and Fibromyalgia

Tomatoes can be a nutritious addition to an arthritis-friendly diet, although they do not cure arthritis or directly reverse joint damage.

• Lycopene: Tomatoes are particularly rich in lycopene, an antioxidant that helps protect cells from oxidative stress. Cooked tomatoes and tomato products can provide especially well-absorbed lycopene.

• Vitamin C: Supports collagen formation and normal connective-tissue function.

• Antioxidants: Tomatoes contain vitamin C, carotenoids, and other plant compounds that contribute to overall antioxidant intake.

• Potential anti-inflammatory effects: Laboratory and observational research suggests that compounds in tomatoes may influence inflammatory pathways, but evidence that eating tomatoes significantly reduces arthritis pain or inflammation in people is still limited.

• Heart health: Tomatoes can contribute to a heart-healthy diet, which is particularly relevant for people with rheumatoid arthritis, because RA is associated with increased cardiovascular risk.

Some people with Diffuse Idiopathic Skeletal Hyperostosis report that tomatoes or other nightshade vegetables worsen their symptoms. There isn’t strong scientific evidence that tomatoes generally cause arthritis inflammation or should routinely be avoided. If you consistently notice symptoms after eating a particular food, discussing this pattern with a healthcare professional or dietitian can be more useful than eliminating foods unnecessarily.

For Diffuse Idiopathic Skeletal Hyperostosis, tomatoes are best viewed as part of an overall nutritious eating pattern. For rheumatoid arthritis, diet can complement medical treatment but shouldn’t replace disease-modifying medication when it is prescribed.