Giant Cell Arteritis - How It Affects the Elderly

Introduction

Giant cell arteritis (GCA), also known as temporal arteritis, is a medical condition that primarily affects people over 50, particularly older adults. Large arteries primarily those in the brain, such as the temporal artery are inflamed as a result. GCA poses a big risk to the senior population because it can result in life-threatening conditions, including blindness and stroke.

What Is the Pathophysiology of Giant Cell Arteritis?

The pathophysiology of giant cell arteritis (GCA) involves inflammation of large and medium-sized arteries, particularly those around the head, like the temporal artery. T-cells and macrophages, two types of immune cells, colonize these arteries and develop into "giant cells." The arterial walls become thicker due to this inflammation, which lowers blood flow. GCA can consequently cause excruciating headaches, jaw pain, and even eyesight issues. It is considered an autoimmune condition, which means the body's immune system unintentionally assaults its own arteries. To avoid GCA-related consequences like blindness and strokes, early diagnosis and treatment are essential.

Who Is at Risk?

GCA typically affects elderly people, with an average age of onset of roughly 70 years. It is more prevalent in those of northern European ancestry and affects women twice as frequently as it does men. Familial clustering evidence suggests a hereditary susceptibility. Therefore, genetics might be involved.

What Are the Clinical Manifestations of Giant Cell Arteritis?

Due to its insignificant and vague symptoms, giant cell arteritis (GCA), sometimes known as the "silent threat," poses a special difficulty, especially in elderly people who may mistake these symptoms for the effects of aging. For an early diagnosis and intervention, it is critical to recognize these clinical manifestations:

1. Headache: GCA frequently manifests with strong, persistent headaches that typically originate in the temple area. These headaches might be deceiving since they resemble tension headaches, which are more typical. It may be difficult to tell the difference between this pain and a typical headache because it may be strong, throbbing, and constant. However, the inability to be treated with common painkillers is a defining feature of GCA-related headaches.

2. Jaw Pain (Jaw Claudication): Jaw claudication, or pain during chewing or talking, is a typical sign of GCA. It happens when the blood flow to the muscles that move the jaw is hampered by inflammation in the temporal arteries. Particularly when eating, patients may experience this pain as a tightness or cramping in the jaw.

3. Vision Problems: One or both eyes may experience a sudden, painless loss of vision as a result of GCA. This symptom is an ophthalmologic emergency and has to be treated right away. Impaired blood flow to the retina or optic nerve causes vision loss. To avoid blindness that is irreversible, treatment must begin right away.

4. Weight Loss and Weariness: Elderly GCA patients may have unexplained weight loss and weariness. These symptoms are frequently connected to the GCA-related chronic inflammatory condition. The body's immune system is working overtime, which causes fatigue and appetite loss that causes weight loss.

How to Diagnose Giant Cell Arteritis?

Giant cell arteritis (GCA) can be diagnosed in a variety of ways, including through clinical assessment, laboratory testing, imaging studies, and temporal artery biopsy, which is frequently regarded as the gold standard for confirmation.

• Clinical Evaluation: A thorough clinical evaluation is often the first step in the diagnosis of GCA. The medical professional obtains a thorough medical history and does a complete physical examination. The patient's age, symptoms, and any GCA risk factors are all given special consideration. The medical history may provide crucial information, such as a history of headache, jaw pain, or visual problems (symptoms that are typical of GCA). The healthcare professional may also ask about any further systemic symptoms, such as fever, exhaustion, or unexplained weight loss, which may also be a sign of the illness.

• Laboratory Tests: Laboratory tests are helpful in the diagnosis of GCA. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), two acute-phase reactants, are related to higher levels when GCA is present. GCA patients frequently have elevated levels of these markers because of the continuing inflammation in the artery walls. It is crucial to remember that normal CRP and ESR readings do not rule out GCA, though. While some people without GCA may have elevated levels as a result of other underlying diseases, some patients with GCA may have normal test findings. These tests are therefore regarded as helpful but not conclusive.

• Imaging Studies: For evaluating GCA, an ultrasound of the temporal arteries is very helpful. The arterial walls can be seen using high-frequency ultrasonography, which can also identify recognizable signs like thickness and inflammation. It is a minimally invasive and reasonably expensive technique for detecting GCA. Additionally, inflammation in big vessels outside of the temporal arteries can be found using positron emission tomography (PET) studies. PET scans give a more comprehensive picture of the level of inflammation, assisting in the diagnosis and monitoring of disease activity.

• Temporal Artery Biopsy: Clinical examination, laboratory testing, and imaging studies can all be instructive, but a temporal artery biopsy is frequently regarded as the gold standard for diagnosing GCA. A little portion of the temporal artery is surgically excised during this treatment, usually close to the hairline. After that, the tissue is inspected under a microscope for GCA-specific symptoms like inflammation and large cells inside the artery walls. The diagnosis is verified by a positive biopsy.

How to Treat Giant Cell Arteritis?

• Immediate Treatment: Once diagnosed, GCA needs to be treated right away with high-dose corticosteroids like Prednisone. This drug aids in reducing inflammation and the immunological response. Treatment should not be postponed while waiting for the findings of the biopsy because there could be serious problems.

• Long-Term Management: To reduce adverse effects, long-term management of GCA requires progressively reducing the dosage of corticosteroids. Some people might need to receive care for a number of years. In order to reduce the dosage of corticosteroids, disease-modifying anti-rheumatic medications (DMARDs), such as Methotrexate, may be used with corticosteroids.

• Monitoring: To judge a treatment's effectiveness and control any adverse effects, regular follow-up and monitoring are crucial. Patients who are elderly may be more susceptible to the side effects of long-term corticosteroid treatment, such as osteoporosis and hypertension.

Conclusion

Giant cell arteritis (GCA), which is characterized by inflammation of major arteries and frequently results in excruciating headaches, jaw pain, vision loss, and other symptoms, is a significant problem among the elderly. Early diagnosis might be difficult due to the disease's concealing nature, but it is essential to avoid complications, including blindness and stroke. Clinical evaluation, blood tests, imaging studies, and occasionally a temporal artery biopsy are used to make the diagnosis. The use of corticosteroids as soon as possible is crucial, followed by long-term therapy and monitoring to reduce adverse effects. The effects of GCA on elderly people go beyond just their physical health; they also have an impact on their emotional health and quality of life.