Giant cell arteritis is a large- and medium-vessel vasculitis that causes inflammation and narrowing of arteries and vessels. It reduces blood flow and can affect the head, neck, and body.
The most common symptom is a new, throbbing headache, often with scalp tenderness, jaw pain with chewing, or visual change. Prompt treatment matters: quick reduction of artery inflammation helps prevent permanent loss of vision.
Diagnosis uses blood tests, imaging like ultrasound with a halo sign, and a temporal artery biopsy. A biopsy of at least 2 cm helps avoid false negatives from skip lesions.
Treatment starts immediately when suspected. If vision is threatened, IV methylprednisolone is used, then oral prednisone at a defined dose and a slow taper while monitoring ESR/CRP. Long-term follow-up checks for complications such as aortic aneurysm.
Key Takeaways
- Giant cell arteritis is a vasculitis that narrows arteries and limits blood flow.
- New headache, jaw pain, scalp sensitivity, or vision change need urgent review.
- Start high-dose steroids promptly if suspected to protect sight.
- Biopsy (≥2 cm) and ultrasound support diagnosis; blood tests monitor activity.
- Severe cases use IV steroids; oral prednisone is tapered over months with close follow-up.
What it is and why early action matters
Giant cell arteritis is an immune-mediated vasculitis that targets large and medium arteries. It causes swelling that narrows the lumen of affected vessels and restricts blood flow to the eye, head, and other organs.
Giant cell disease as a large- and medium-vessel disorder
This process most often involves branches of the carotid, including the temporal arteries, and can extend to the aorta. The immune system’s attack on the artery wall leads to inflammation that risks ocular ischemia and aortic complications.
Who is at risk in the United States
The condition mainly affects people over age 50. U.S. estimates suggest about 15–25 cases per 100,000 per year in this group. Those of Northern European or Scandinavian ancestry and cisgender females have higher incidence.
- Early steroid therapy at first suspicion reduces the chance of arteritic anterior ischemic optic neuropathy.
- Recognizing systemic disease prompts surveillance of blood vessels beyond the head.
How to recognize temporal arteritis symptoms
A fresh, one-sided head pain that worsens with brushing or touching the scalp can point to an urgent vascular problem. People often describe a new throbbing headache with scalp tenderness. Palpation may reveal a tender, thickened, or less pulsatile temporal artery.
Jaw, throat and cough clues
Jaw claudication — pain or fatigue when chewing — is a high-risk sign of muscle ischemia supplied by inflamed cranial arteries. Throat or tongue pain, hoarseness, or a persistent cough may also occur and support clinical suspicion.
Vision warning signs
Visual symptoms range from brief blurring or double vision to a curtain-like loss. Sudden, painless profound vision loss from arteritic anterior ischemic optic neuropathy (AAION) is an emergency and can lead to permanent blindness.
Systemic and limb findings
Systemic clues include fever, fatigue, anorexia, and unintentional weight loss. Shoulder and hip stiffness suggest polymyalgia symptoms. Limb ischemia may cause arm or leg pain, coolness, or digital changes. Silent aortic inflammation can later present as aneurysm — unexplained fevers or persistent inflammation are red flags.
- Labs: ESR and CRP are often elevated, but up to 20% of biopsy-proven cases have a normal erythrocyte sedimentation rate.
- Any combination of these symptoms after age 50 warrants urgent evaluation to reduce risk of lasting vision loss or vascular complications.
For more on facial rejuvenation procedures that reference the area and arteries involved, see temporal face lift info.
When to seek urgent medical care
Sudden vision change or new jaw pain in adults over 50 requires immediate evaluation. Rapid assessment in an emergency department or urgent care shortens time to lifesaving treatment.
Immediate steps if vision changes or jaw claudication occur
Clinicians typically begin high-dose corticosteroids right away to protect eyesight. If vision is threatened, an intravenous course such as methylprednisolone 1 g daily for 3 days is often given, then patients switch to oral prednisone 40–60 mg/day.
Do not delay therapy for confirmatory tests. A temporal artery biopsy may follow; histology often remains diagnostic for 6–8 weeks after starting steroids.
Why suspected cases should start treatment without delay
Early therapy lowers the risk of permanent vision loss and other ischemic complications such as stroke or limb-threatening ischemia. Patients should not drive if vision is affected and should bring a current medication list to speed care decisions.
- Report exact onset time of symptoms to guide dosing and tests.
- Treatment prioritizes preservation of sight over waiting for biopsy results.
- Expect coordinated follow-up with emergency, rheumatology, and ophthalmology teams.
| Presentation | Immediate action | Typical dose |
|---|---|---|
| Acute vision change | Start IV steroids; arrange ophthalmology | Methylprednisolone 1 g/day ×3 days |
| Jaw claudication or severe new pain | Begin high-dose oral steroids; urgent evaluation | Prednisone 40–60 mg/day |
| Suspected but no vision loss | Start treatment; schedule biopsy and tests | Prednisone individualized by clinician |
Temporal arteritis diagnosis: tests, biopsy, and imaging
Accurate diagnosis relies on a combination of targeted tests, imaging, and tissue sampling. Early laboratory work and prompt imaging help confirm suspicion and guide urgent care without delaying therapy.
ESR, CRP, and platelet count: what elevated inflammatory markers mean
Clinicians order ESR, CRP, and platelet counts early because elevated markers support the diagnosis and track response. CRP is more sensitive than erythrocyte sedimentation rate, and a high CRP together with platelets >400,000 raises specificity.
A normal sedimentation rate does not rule out disease; up to one in five biopsy-proven cases have a normal ESR before treatment.
Temporal artery biopsy: gold standard, skip lesions, and length
A carefully obtained biopsy of the temporal artery remains the gold standard. Request at least a 2 cm specimen to reduce false negatives from skip lesions.
If the first biopsy is negative but clinical suspicion stays high, sampling the contralateral artery can increase yield. Histology typically shows panarteritis, disruption of the internal elastic lamina, and an inflammatory infiltrate that may include giant cells; their absence does not exclude disease.
Ultrasound “halo sign” and other imaging adjuncts
Color Doppler ultrasound can reveal a hypoechoic, noncompressible “halo sign” that suggests vessel wall edema. Specificity is high (≈89–91%), but sensitivity varies and the test is operator dependent.
CT angiography or PET can evaluate extracranial large-vessel involvement such as the aorta when clinicians suspect wider disease.
- Order baseline blood tests before or immediately after starting steroids to document trends.
- Begin treatment without waiting for biopsy when vision is at risk; histopathology stays detectable for 6–8 weeks after steroids.
| Test | Role | Notes |
|---|---|---|
| ESR / CRP | Screening & monitoring | CRP more sensitive; combinations improve specificity |
| Biopsy | Confirm diagnosis | ≥2 cm recommended; consider bilateral sampling |
| Ultrasound / CTA / PET | Adjunct imaging | Halo sign specific but operator dependent; CTA/PET for large-vessel disease |
Treatment guide: how to start, dose, and taper corticosteroids
Initial goals are rapid control of artery inflammation to prevent ischemic harm, especially vision loss. Providers start therapy at first suspicion and tailor the approach to whether sight is threatened.
Starting doses: oral vs IV
For most cases, begin oral prednisone 40–60 mg/day. If vision is at risk, give IV methylprednisolone 1 g daily for 3 days, then switch to high-dose oral prednisone.
Tapering schedule and monitoring
Maintain the initial high dose for about 4 weeks, then reduce gradually. A common plan lowers by ~10 mg monthly to 10–15 mg/day, then by 1–2.5 mg/month.
Check symptoms and blood markers (CRP and erythrocyte sedimentation rate) regularly. ESR can lag behind clinical improvement, so treat trends and symptoms together.
Preventing relapse during the taper
If headaches, jaw pain, or visual symptoms recur or markers rise, increase the steroid dose temporarily and consider a steroid-sparing agent. Educate patients not to change doses without clinician input.
- Follow-up: visits every 2–4 weeks early on; labs with each adjustment.
- Safety: screen for diabetes, hypertension, bone loss and drug interactions before and during therapy.
- Duration: most courses last ~1 year; relapses may extend treatment or prompt add-on therapy.
| Scenario | Initial action | Typical dose | Monitoring |
|---|---|---|---|
| Vision threatened | Immediate IV then oral steroids | Methylprednisolone 1 g/day ×3 days → high-dose prednisone | Ophthalmology, CRP, ESR, visual exam |
| No vision loss | Start oral steroids without delay | Prednisone 40–60 mg/day | CRP/ESR trends, symptoms, monthly visits |
| Relapse during taper | Increase dose; consider steroid-sparing therapy | Individualized by clinician | Close labs, specialist input |
Steroid-sparing strategies and side-effect management
Long-term high-dose corticosteroids effectively control inflammation but carry significant risks. Adding targeted therapies or preventive measures can lower steroid exposure and protect health while preserving vision and vessel integrity.
Tocilizumab and methotrexate as add-on therapies
Tocilizumab (Actemra) is FDA-approved for giant cell arteritis and can reduce cumulative steroid needs. It suits patients at high risk for steroid toxicity or those with recurrent disease.
Methotrexate may lower relapse rates and overall steroid dose for some patients. Both agents require lab monitoring and infection‑risk counseling before and during therapy.
“Adding a steroid-sparing agent can reduce total steroid exposure and help maintain remission.”
Managing corticosteroid adverse effects: bone, eye, metabolic
Long-term steroids raise the risk of osteoporosis, diabetes, hypertension, infection, cataract, and glaucoma. Preventive steps include calcium and vitamin D supplementation and baseline bone density testing.
Coordinate care to monitor blood glucose, blood pressure, weight, and perform periodic eye exams. Consider bisphosphonates for fracture risk and review vaccinations before immunosuppression.
Role of low-dose aspirin and lifestyle measures
Low-dose aspirin may lower ischemic complications in some cohorts; clinicians individualize use after weighing bleeding risk. Encourage smoking cessation, weight-bearing exercise, reduced salt, and balanced nutrition.
Patients should be taught infection precautions and have a clear follow-up plan for labs and safety checks when starting any steroid-sparing regimen.
| Intervention | Benefit | Monitoring |
|---|---|---|
| Tocilizumab | Lower steroid burden; reduce relapses | CRP, LFTs, infection screening, vaccination review |
| Methotrexate | May reduce relapse frequency and steroid dose | LFTs, CBC, pregnancy counseling, folic acid supplement |
| Preventive care | Reduce fractures, metabolic complications, eye disease | DEXA scan, BP/glucose checks, ophthalmology visits |
| Low‑dose aspirin | Possible reduction in ischemic events | Bleeding risk assessment; individualized decision |
For related immune-mediated vascular care and treatment options, see treatment of Behçet’s disease.
Complications, prognosis, and long-term follow-up
Ongoing surveillance after initial treatment is essential to spot silent aortic disease and reduce catastrophic events.
Preventing vision loss and monitoring aortic disease
Vision loss from AAION is the most serious complication and may be permanent. Prompt high‑dose steroids preserve remaining sight when given quickly.
Large‑vessel involvement beyond the head occurs commonly and can include aortitis with aneurysm or dissection. Guidelines recommend periodic imaging of the aorta and major arteries to detect problems before they become life‑threatening.
Recurrence risk, specialist care, and support resources
Recurrence often appears during steroid taper; scheduled visits and lab checks help catch flares early. Rheumatology coordinates systemic care while ophthalmology monitors the eye and visual fields.
- Patients with hypertension, strong polymyalgia symptoms, or very high inflammatory markers need closer vascular follow‑up.
- Limb ischemia may cause digital pain, ulcers, or claudication; report new extremity symptoms immediately.
- Learn emergency signs—new vision changes or severe chest/back pain—and call 911 if they occur.
Support groups improve coping and adherence. For related vision and nerve care, see neuro‑ophthalmology.
Conclusion
Early warning signs such as a new headache, jaw pain with chewing, or sudden visual change in adults over 50 demand fast action to reduce the risk of permanent loss of vision.
With suspected temporal arteritis, begin immediate corticosteroid treatment while arranging prompt tests—blood work, biopsy, and targeted imaging—to secure a timely diagnosis and protect the eye and other vessels.
Long-term care blends a structured steroid taper, steroid-sparing drugs, lifestyle measures, and coordinated specialist follow-up to manage this giant cell arteritis as a chronic vasculitis of the arterial system.
Stay alert for red flags—new vision changes or severe chest/back pain—and seek urgent care. With rapid response and multidisciplinary support, most people maintain quality of life and independence.
