Overview

Temporal arteritis (giant cell arteritis) is where the arteries, particularly those at the side of the head (the temples), become inflamed. It's a serious condition that requires urgent treatment.

Symptoms of temporal arteritis

The symptoms of temporal arteritis depend on which arteries are affected.

The main symptoms are:

  • frequent, severe headaches
  • pain and tenderness over the temples
  • jaw pain while eating or talking
  • vision problems, such as double vision or a loss of vision in 1 or both eyes

More general symptoms are also common – for example, flu-like symptoms, unintentional weight loss, depression and tiredness.

Around half of all people with temporal arteritis also develop polymyalgia rheumatica, which causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips.

Get advice from NHS 111 Wales (if available in your area) or 0845 46 47 now if:

  • you think you might have temporal arteritis

It can lead to serious problems like stroke and blindness if not treated quickly.

NHS 111 Wales or 0845 46 47 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

What happens at your appointment

Your GP will ask you about your symptoms and examine your temples.

After having some blood tests, you'll be referred to a specialist.

They may carry out further tests to help diagnose temporal arteritis.

You may have:

  • an ultrasound scan of your temples
  • a biopsy under local anaesthetic, where a small piece of the temporal artery is removed and checked for signs of temporal arteritis

If you have problems with your vision, you should have a same-day appointment with an eye specialist (ophthalmologist) at a hospital eye department.

Treatment for temporal arteritis

Temporal arteritis is treated with steroid medicine, usually prednisolone.

Treatment will be started before temporal arteritis is confirmed because of the risk of vision loss if it's not dealt with quickly.

There are 2 stages of treatment:

  1. An initial high dose of steroids for a few weeks to help bring your symptoms under control.
  2. A lower steroid dose (after your symptoms have improved) given over a longer period of time, possibly several years.

A small number of people may need to take steroids for the rest of their life.

You'll have regular follow-ups to see how you're doing and check for any side effects you may have.

Using steroids

Do not suddenly stop taking steroids unless your doctor tells you to. Doing so could make you very ill.

Other treatments

Other types of medication you may need if you have temporal arteritis include:

  • low-dose aspirin – to reduce the risk of stroke or a heart attack, which can happen if the arteries to your heart are affected
  • proton pump inhibitors (PPIs) – to lower your risk of getting a stomach problem like indigestion or a stomach ulcer, which can be a side effect of taking prednisolone
  • bisphosphonate therapy – to reduce the risk of osteoporosis when taking prednisolone
  • immunosuppressants – to allow steroid medication to be reduced and help prevent temporal arteritis coming back

Symptoms

The most common symptom of giant cell arteritis (GCA) is a headache, although some people also experience jaw pain and vision problems.

The symptoms usually develop quite quickly, although many people report other symptoms, such as weight loss or tiredness, for weeks or months beforehand.

Headache

About two-thirds of people with giant cell arteritis experience a headache that develops suddenly. It most often affects the front or side of the head (temples), but can also affect the back or top of the head, or behind the ears. These areas may also feel tender.

Many people with giant cell arteritis have described the headache as unlike any type of headache they've experienced before. Painkillers, such as paracetamol, aren't usually effective at treating the pain.

Your scalp may also feel sore and tender when brushing your hair. In many cases, the arteries in the temples (temporal arteries) are visibly swollen.

Jaw pain and vision problems

Although less common, people with giant cell arteritis may also experience jaw pain (jaw claudication) and problems with vision.

Jaw pain typically occurs when chewing or talking. The pain usually stops when the jaw is rested. In some cases, the pain is felt in the tongue.

Vision problems affect about one in five people with giant cell arteritis. This can be in one or both eyes. It's been described as like having a shade covering your eye. Left untreated, it can lead to blindness.

Many people will experience episodes of double vision before the loss of vision occurs.

Other symptoms

Other common symptoms of giant cell arteritis include:

  • mild fever, with a temperature of 37-38C (98.6-100.4F)
  • extreme tiredness
  • loss of appetite
  • weight loss
  • depression

When to seek medical advice

It's very important that giant cell arteritis is treated as soon as possible to reduce the risk of blindness. However, this can be difficult because the initial symptoms of giant cell arteritis can often be vague.

Warning signs that your vision may be at risk include:

  • suddenly developing a severe headache
  • pain in your jaw muscles when eating
  • double vision
  • your scalp is sore or tender to the touch

Contact your GP immediately if you develop any of these symptoms. If this isn't possible, call NHS 111 Wales (if available in your area) or 0845 46 47 or your local out-of-hours service.

Polymyalgia rheumatica

Around half of people with giant cell arteritis also develop a condition that causes inflammation of the muscles called polymyalgia rheumatica.

If you have giant cell arteritis, you therefore may also have symptoms of polymyalgia rheumatica, such as shoulder, neck and hip pain, and muscle stiffness.

Diagnosis

If your GP suspects you have giant cell arteritis (GCA), they'll ask you about your symptoms and examine your head.

This is because giant cell arteritis can cause physical signs, such as noticeably swollen arteries in your temples.

Blood tests

If your GP suspects you may have giant cell arteritis, they'll refer you for blood tests to help assess the levels of inflammation inside your body.

Two blood tests that you may have are erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These tests are useful for assessing conditions associated with short- or long-term inflammation.

Lab Tests Online UK has more information about ESR and CRP tests.

Eye tests

If you have vision problems, it's likely your GP will arrange a same-day appointment with an eye specialist (ophthalmologist). This will usually be at your local hospital or eye clinic.

The ophthalmologist will check your eyes for changes associated with giant cell arteritis, such as bleeding or swelling at the site of your optic nerve (the nerve at the back of the eye that transmits signals to the brain).

Temporal artery biopsy

A temporal artery biopsy is most commonly used to test for giant cell arteritis.

During the procedure, the skin on the side of your head is numbed with a local anaesthetic. An incision is made close to the hairline in front of your ear, and a small sample of your temporal artery is removed. The incision will then be sealed with stitches.

The sample can be studied under a microscope in a laboratory to check for damage and inflammation of the lining of the arteries. It can take several days to get the results of a biopsy.

If giant cell arteritis is suspected, treatment with steroid medication (corticosteroids) will usually begin immediately. Waiting until the results of the biopsy are known could affect your sight.

Read more about treating giant cell arteritis.

Cranial ultrasound

Research has shown cranial ultrasound is a simple and accurate diagnostic test for giant cell arteritis. However, the procedure is still quite new and there are only a few rheumatologists in the UK who carry out the technique, so availability is currently limited.

Accurately diagnosing giant cell arteritis is very important because it ensures people with the condition continue to receive steroid treatment to help prevent visual impairment.

This also ensures that those who no longer have the condition don't continue receiving steroid treatment unnecessarily. Long-term steroid use can cause side effects.

Treatment

Steroid medication (corticosteroids) is the preferred treatment for giant cell arteritis (GCA). A type of steroid medicine called prednisolone is usually prescribed.

Prednisolone

If your vision is at risk, you may be given an initial prednisolone injection. After this, prednisolone tablets will be prescribed.

If your vision isn't at risk, you'll be prescribed prednisolone tablets or capsules straight away. You'll probably start on a relatively high dose, which will gradually be reduced every two to four weeks, depending on how well you respond to treatment.

You may need to take prednisolone for up to two years to prevent your symptoms returning. Your symptoms should improve significantly within a few days of starting treatment. However, there's a chance they'll return (relapse) once treatment stops.

Don't suddenly stop taking steroid medication unless you're told by a doctor that it's safe to do so. Suddenly stopping steroid treatment can make you feel very ill.

Side effects

About 1 in 20 people who take prednisolone will experience changes in their mental state when they take the medication.

For example, you may feel very depressed and suicidal, very anxious, or very confused. Some people also experience hallucinations (feeling, seeing or hearing things that aren't there). Contact your GP as soon as possible if you experience changes to your mental state.

Other side effects of prednisolone include:

  • increased appetite, which often leads to weight gain
  • increased blood pressure
  • mood changes, such as becoming aggressive or irritable with people
  • weakening of the bones (osteoporosis)
  • stomach ulcers
  • increased risk of infection – particularly to the virus that causes chickenpox and shingles (varicella-zoster virus).

Seek immediate medical advice if you think you've been exposed to the varicella-zoster virus, or if a member of your household develops chickenpox or shingles.

The risk of these side effects should improve as your dosage of prednisolone is decreased.

See side effects of corticosteroids for more information about how these side effects may affect you and how they're treated.

Low-dose aspirin

Low-dose aspirin is increasingly being recommended for people with a history of giant cell arteritis. It has been found to be effective in preventing complications of giant cell arteritis, such as heart attacks or stroke.

If you're prescribed steroid medication and low-dose aspirin, another medication called omeprazole may also be recommended. Omeprazole belongs to a class of medicines called proton-pump inhibitors, and it can be used to help protect your stomach from stomach ulcers.

Immunosuppressants

Some people with giant cell arteritis may benefit from treatment with immunosuppressants, such as methotrexate or leflunomide, which are taken along with prednisolone. Omeprazole may also be recommended to help prevent stomach ulcers.

Immunosuppressants are a type of medication used to suppress the immune system (the body's defence against infection and illness). Using immunosuppressants can allow steroid medication to be reduced, and can help prevent the condition recurring.

Common side effects of immunosuppressant medication include nausea, vomiting, diarrhoea, and skin rashes.

Follow-up

The doctor in charge of your care will ask you to attend regular follow-up appointments so they can check how well you're responding to treatment. They'll assess whether your dosage of prednisolone needs to be adjusted and how well you're coping with the side effects of the medication.

Follow-up appointments are usually recommended on a weekly or fortnightly basis for the first two or three months of your treatment, and then every three months after that.

During these appointments, you'll have further blood tests to check the levels of inflammation inside your body. If you had a CRP test that indicated high levels of inflammation, you may have another one four weeks after starting steroid treatment.

The second CRP test should show that the inflammation has dropped to normal levels. You may also be referred for scans to assess how strong your bones are.

If you experience a return of your symptoms during any part of your treatment, contact your doctor as your dosage may need to be adjusted.

Steroid card

If you need to take steroids for more than three weeks, your GP or pharmacist should arrange for you to be issued with a steroid card.

It's important to carry the steroid card with you at all times as it will explain that you're regularly taking steroids and your dose shouldn't suddenly be stopped.

This information may prove very important for healthcare professionals who need to treat you in the event of a sudden illness, accident, or emergency.

Complications

People with giant cell arteritis (GCA) can sometimes develop further problems associated with the condition.

Visual loss

Around one in five people with giant cell arteritis will experience some degree of visual loss. This can range from some vision loss in one eye to total blindness.

Coming to terms with any degree of sight loss can be overwhelming, and you'll probably require a great deal of help and support.

You may find it useful to contact the Royal National Institute of Blind People (RNIB), the UK's leading charity for people affected by visual impairment.

Abdominal aortic aneurysm

Inflammation associated with giant cell arteritis can sometimes weaken the walls of the abdominal aorta. This is the main blood vessel responsible for taking blood from the heart and distributing it to the rest of the body.

Weakened walls of the abdominal aorta can cause a bulge to form, known as an aneurysm. An abdominal aortic aneurysm is potentially very serious because there's a risk that the blood vessel could rupture, causing massive internal bleeding and, in most cases, death.

Because of this risk, it may be recommended that you have a check-up every two years if you have a history of giant cell arteritis. Tests such as ultrasound scans and X-rays can be used to check if you have developed an abdominal aortic aneurysm.

If a significant aneurysm is detected, a type of surgery known as grafting is usually recommended. This involves removing the section of the aorta that contains the aneurysm and replacing it with a piece of synthetic tubing called a graft.

Read more about treating an abdominal aortic aneurysm.

Cardiovascular disease

People with giant cell arteritis also have an increased risk of developing cardiovascular disease. This is the general term for disease of the heart or blood vessels, and it's a leading cause of stroke and heart attacks.

Treatment for giant cell arteritis, such as low-dose aspirin, can help reduce the risk of cardiovascular disease.



The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 07/05/2021 14:25:11