eMedicine Specialties > Neurology > Inflammatory and Demyelinating Diseases

Temporal/Giant Cell Arteritis: Follow-up

Author: Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Coauthor(s): Arun Ramachandran, State University of New York Upstate Medical University
Contributor Information and Disclosures

Updated: Jun 22, 2009

Follow-up

Further Outpatient Care

Giant cell arteritis (GCA) is treated primarily in an outpatient setting. The median duration of symptoms before diagnosis is 1 month.

  • Ongoing monitoring of symptoms and ESR are mandatory.
  • ESR often normalizes within days of instituting steroid therapy.
  • With tapering steroid doses, ischemic complications may occur at any time but tend to occur a median of 1 month after beginning therapy.
  • The typical patient with GCA remains on steroid therapy for roughly 2 years.

Deterrence/Prevention

No effective prevention strategies are known.

Complications

  • Complications of GCA result from ischemic complications of vasculitis and are discussed in Clinical.
  • Sequelae of steroid therapy include acute and chronic adverse effects and are discussed in Treatment and Medication.
    • Because of the high frequency of chronic adverse effects, TAB confirmation of diagnosis is highly desirable.
    • Patients with GCA suffer the following steroid-related complications during the course of their treatment: vertebral body compression fracture (26%), symptomatic steroid myopathy (11%), steroid psychosis (3%).

Prognosis

  • With prompt, adequate therapy, full recovery is the rule.
    • The reduced rate of neuro-ophthalmologic complications in recent years reflects improved recognition and treatment.
    • Blindness is now a rare complication.
  • Untreated, the prognosis for the patient with GCA is extremely poor, with blindness or death resulting from myocardial infarction, stroke, or dissecting aortic aneurysm. Vision loss in the second eye may occur even after the initiation of treatment (possibly because those vessels have already been affected by arteritis) in 6-13% of patients.
  • While morbidity and mortality have improved significantly with corticosteroid therapy, a higher mortality after treatment and definitely a higher morbidity caused by the corticosteroids have been reported.

Patient Education

  • Symptomatic relapse: Patients must be instructed concerning the seriousness of symptomatic relapses so that prompt medical attention is sought.
  • Steroid use: Patients must know the importance of strictly adhering to their steroid dose schedule and, if necessary, must utilize ancillary interventions such as dietary restrictions that can reduce the incidence of steroid-related adverse effects.

Miscellaneous

Medicolegal Pitfalls

  • GCA causes blindness, and this dread complication can be prevented with prompt diagnosis and institution of therapy. Failure to do so represents a medicolegal pitfall in addition to suboptimal medical practice.
  • Steroid-related complications such as vertebral compression fracture can become a source of chronic pain and disability, but they are not prevented easily or reliably. To avoid misunderstandings, inform patients and their families about this and other potential complications that can occur even with proper therapy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Richard J. Caselli, MD to the development and writing of this article.



More on Temporal/Giant Cell Arteritis

Overview: Temporal/Giant Cell Arteritis
Differential Diagnoses & Workup: Temporal/Giant Cell Arteritis
Treatment & Medication: Temporal/Giant Cell Arteritis
Follow-up: Temporal/Giant Cell Arteritis
Multimedia: Temporal/Giant Cell Arteritis
References
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References

  1. Cantini F, Niccoli L, Storri L, Nannini C, Olivieri I, Padula A. Are polymyalgia rheumatica and giant cell arteritis the same disease?. Semin Arthritis Rheum. Apr 2004;33(5):294-301. [Medline].

  2. Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. Mar-Apr 2007;15(2):55-61. [Medline].

  3. Nordborg C, Larsson K, Aman P, Nordborg E. Expression of the class I interferon-related MxA protein in temporal arteries in polymyalgia rheumatica and temporal arteritis. Scand J Rheumatol. Mar-Apr 2009;38(2):144-8. [Medline].

  4. Rodríguez-Pla A, Bosch-Gil JA, Rosselló-Urgell J, Huguet-Redecilla P, Stone JH, Vilardell-Tarres M. Metalloproteinase-2 and -9 in giant cell arteritis: involvement in vascular remodeling. Circulation. Jul 12 2005;112(2):264-9. [Medline].

  5. Mehler MF, Rabinowich L. The clinical neuro-ophthalmologic spectrum of temporal arteritis. Am J Med. Dec 1988;85(6):839-44. [Medline].

  6. Solans-Laqué R, Bosch-Gil JA, Molina-Catenario CA, Ortega-Aznar A, Alvarez-Sabin J, Vilardell-Tarres M. Stroke and multi-infarct dementia as presenting symptoms of giant cell arteritis: report of 7 cases and review of the literature. Medicine (Baltimore). Nov 2008;87(6):335-44. [Medline].

  7. Onuma K, Chu CT, Dabbs DJ. Asymptomatic giant-cell (temporal) arteritis involving the bilateral adnexa: case report and literature review. Int J Gynecol Pathol. Jul 2007;26(3):352-5. [Medline].

  8. Adams WB, Becknell CA. Rare manifestation of scalp necrosis in temporal arteritis. Arch Dermatol. Aug 2007;143(8):1079-80. [Medline].

  9. Goicochea M, Correale J, Bonamico L, Dominguez R, Bagg E, Famulari A. Tongue necrosis in temporal arteritis. Headache. Sep 2007;47(8):1213-5. [Medline].

  10. Loddenkemper T, Sharma P, Katzan I, Plant GT. Risk factors for early visual deterioration in temporal arteritis. J Neurol Neurosurg Psychiatry. Nov 2007;78(11):1255-9. [Medline].

  11. Ortiz Z, Tugwell P. Raised ESR in polymyalgia rheumatica no longer a sine qua non?. Lancet. Jul 6 1996;348(9019):4-5. [Medline].

  12. Hayreh SS, Podhajsky PA, Raman R, Zimmerman B. Giant cell arteritis: validity and reliability of various diagnostic criteria. Am J Ophthalmol. Mar 1997;123(3):285-96. [Medline].

  13. Salvarani C, Cantini F, Boiardi L, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. Jul 25 2002;347(4):261-71. [Medline].

  14. Costello F, Zimmerman MB, Podhajsky PA, Hayreh SS. Role of thrombocytosis in diagnosis of giant cell arteritis and differentiation of arteritic from non-arteritic anterior ischemic optic neuropathy. Eur J Ophthalmol. May-Jun 2004;14(3):245-57. [Medline].

  15. Parikh M, Miller NR, Lee AG, Savino PJ, Vacarezza MN, Cornblath W. Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology. Oct 2006;113(10):1842-5. [Medline].

  16. Foroozan R, Danesh-Meyer H, Savino PJ, Gamble G, Mekari-Sabbagh ON, Sergott RC. Thrombocytosis in patients with biopsy-proven giant cell arteritis. Ophthalmology. Jul 2002;109(7):1267-71. [Medline].

  17. Bley TA, Reinhard M, Hauenstein C, Markl M, Warnatz K, Hetzel A. Comparison of duplex sonography and high-resolution magnetic resonance imaging in the diagnosis of giant cell (temporal) arteritis. Arthritis Rheum. Aug 2008;58(8):2574-8. [Medline].

  18. Reinhard M, Schmidt D, Schumacher M, Hetzel A. Involvement of the vertebral arteries in giant cell arteritis mimicking vertebral dissection. J Neurol. Aug 2003;250(8):1006-9. [Medline].

  19. Schmidt WA, Blockmans D. Use of ultrasonography and positron emission tomography in the diagnosis and assessment of large-vessel vasculitis. Curr Opin Rheumatol. Jan 2005;17(1):9-15. [Medline].

  20. Calabrese LH. Clinical management issues in vasculitis. Angiographically defined angiitis of the central nervous system: diagnostic and therapeutic dilemmas. Clin Exp Rheumatol. Nov-Dec 2003;21(6 Suppl 32):S127-30. [Medline].

  21. Warrington KJ, Matteson EL. Management guidelines and outcome measures in giant cell arteritis (GCA). Clin Exp Rheumatol. Nov-Dec 2007;25(6 Suppl 47):137-41. [Medline].

  22. Salvarani C, Giannini C, Miller DV, Hunder G. Giant cell arteritis: Involvement of intracranial arteries. Arthritis Rheum. Dec 15 2006;55(6):985-9. [Medline].

  23. Lenton J, Donnelly R, Nash JR. Does temporal artery biopsy influence the management of temporal arteritis?. QJM. Jan 2006;99(1):33-6. [Medline].

  24. Armstrong AT, Tyler WB, Wood GC, Harrington TM. Clinical importance of the presence of giant cells in temporal arteritis. J Clin Pathol. May 2008;61(5):669-71. [Medline].

  25. Alberts MS, Mosen DM. Diagnosing temporal arteritis: duplex vs. biopsy. QJM. Dec 2007;100(12):785-9. [Medline].

  26. Pountain G, Hazleman B. ABC of rheumatology. Polymyalgia rheumatica and giant cell arteritis. BMJ. Apr 22 1995;310(6986):1057-9. [Medline].

  27. Bley TA, Wieben O, Leupold J. Images in cardiovascular medicine. Magnetic resonance imaging findings in temporal arteritis. Circulation. Apr 26 2005;111(16):e260. [Medline].

  28. Calamia KT, Hunder GG. Clinical manifestations of giant cell (temporal) arteritis. Clin Rheum Dis. 1980;6:389-415.

  29. Caselli RJ. Giant cell (temporal) arteritis: a treatable cause of multi-infarct dementia. Neurology. May 1990;40(5):753-5. [Medline].

  30. Caselli RJ, Daube JR, Hunder GG, Whisnant JP. Peripheral neuropathic syndromes in giant cell (temporal) arteritis. Neurology. May 1988;38(5):685-9. [Medline].

  31. Caselli RJ, Hunder GG. Neurologic aspects of giant cell (temporal) arteritis. Rheum Dis Clin North Am. Nov 1993;19(4):941-53. [Medline].

  32. Caselli RJ, Hunder GG, Whisnant JP. Neurologic disease in biopsy-proven giant cell (temporal) arteritis. Neurology. Mar 1988;38(3):352-9. [Medline].

  33. Fox GN. Giant cell arteritis. CMAJ. Dec 6 2005;173(12):1490; author reply 1490. [Medline].

  34. Gonzalez-Gay MA, Lopez-Diaz MJ, Barros S. Giant cell arteritis: laboratory tests at the time of diagnosis in a series of 240 patients. Medicine (Baltimore). Sep 2005;84(5):277-90. [Medline].

  35. Hajj-Ali RA, Furlan A, Abou-Chebel A, Calabrese LH. Benign angiopathy of the central nervous system: cohort of 16 patients with clinical course and long-term followup. Arthritis Rheum. Dec 15 2002;47(6):662-9. [Medline].

  36. Hollenhorst RW, Brown JR, Wagener HP, Shick RM. Neurologic aspects of temporal arteritis. Neurology. May 1960;10:490-8. [Medline].

  37. Huston KA, Hunder GG, Lie JT, et al. Temporal arteritis: a 25-year epidemiologic, clinical, and pathologic study. Ann Intern Med. Feb 1978;88(2):162-7. [Medline].

  38. Klein RG, Hunder GG, Stanson AW, Sheps SG. Large artery involvement in giant cell (temporal) arteritis. Ann Intern Med. Dec 1975;83(6):806-12. [Medline].

  39. Meyers AD, Said S. Temporal artery biopsy: concise guidelines for otolaryngologists. Laryngoscope. Nov 2004;114(11):2056-9. [Medline].

  40. Narváez J, Narváez JA, Nolla JM, Sirvent E, Reina D, Valverde J. Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis. Rheumatology (Oxford). Apr 2005;44(4):479-83. [Medline].

  41. Ostberg G. Morphological changes in the large arteries in polymyalgia arteritica. Acta Med Scand Suppl. 1972;533:135-59. [Medline].

  42. Polak P, Pokorny V, Stvrtina S, et al. Temporal arteritis presenting with paresis of the oculomotor nerve, and polymyalgia rheumatica, despite a low erythrocyte sedimentation rate. J Clin Rheumatol. Aug 2005;11(4):242-4. [Medline].

  43. Weyand CM, Goronzy JJ. Pathogenic principles in giant cell arteritis. Int J Cardiol. Aug 31 2000;75 Suppl 1:S9-S15; discussion S17-9. [Medline].

  44. Wilkinson IM, Russell RW. Arteries of the head and neck in giant cell arteritis. A pathologicalstudy to show the pattern of arterial involvement. Arch Neurol. Nov 1972;27(5):378-91. [Medline].

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Further Reading

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Keywords

cranial arteritis, giant cell arteritis, GCA, granulomatous arteritis, Horton syndrome, polymyalgia arteritica, polymyalgia rheumatica, polymyalgia, temporal arteritis, anterior ischemic optic neuropathy, AION

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Contributor Information and Disclosures

Author

Tarakad S Ramachandran, MBBS, FRCP(C), FACP, Professor of Neurology, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Chair, Department of Neurology, Crouse Irving Memorial Hospital
Tarakad S Ramachandran, MBBS, FRCP(C), FACP is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners, American College of International Physicians, American College of Managed Care Medicine, American College of Physicians, American Heart Association, American Stroke Association, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Abbott Labs  Honoraria Consulting; Teva Marion Honoraria Consulting; Boeringer-Ingelheim Honoraria Speaking and teaching

Coauthor(s)

Arun Ramachandran, State University of New York Upstate Medical University
Arun Ramachandran is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Jorge E Mendizabal, MD, Consulting Staff, Corpus Christi Neurology
Jorge E Mendizabal, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, National Stroke Association, and Stroke Council of the American Heart Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Michael K Racke, MD, Professor of Neurology and Molecular Virology, Immunology, and Medical Genetics, Chairman of Neurology, Chief of Neurology Service, Ohio State University Medical Center
Michael K Racke, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Association for the Advancement of Science, American Association of Immunologists, and American Neurological Association
Disclosure: Teva Neuroscience Consulting fee Consulting; Peptimmune Inc. Consulting fee Consulting; Bristol Myers Squibb Consulting fee Consulting; EMD Serono Honoraria Speaking and teaching

 
 
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