Symptoms of Giant Cell Arteritis

Symptoms of Giant Cell Arteritis

The symptoms of giant cell arteritis can be wide-ranging and often develop gradually, though in some cases, they appear suddenly. Giant cell arteritis is an inflammatory condition that primarily affects the large and medium arteries of the head and neck, especially the temporal arteries. Recognising the early signs of this condition is essential, as delayed diagnosis can result in serious complications, including permanent vision loss or stroke.

Because the symptoms can mimic other conditions—such as tension headaches, dental problems, or sinus infections—early identification can be challenging. However, there are hallmark symptoms that should prompt immediate medical evaluation, particularly in people over the age of 50.

Classic Symptoms

Giant cell arteritis has a set of “classic” symptoms that often occur together or in close succession:

1. New-Onset Headache

The most common symptom, affecting around two-thirds of patients

Typically located at the temples, but may affect other parts of the head

Often throbbing or aching, sometimes worse at night or with touch

Unlike migraines or cluster headaches, GCA headaches are persistent and unresponsive to typical over-the-counter medication

Patients frequently describe the pain as different from any headache they’ve had before, which should raise clinical suspicion.

2. Scalp Tenderness

Pain or discomfort when brushing hair or wearing a hat

The scalp may feel sore or bruised without visible signs

Sensitive to light pressure, even from lying on a pillow

This symptom is particularly associated with inflammation of the superficial temporal arteries.

3. Jaw Claudication

Pain or cramping in the jaw when chewing, talking, or yawning

Caused by reduced blood flow to the muscles of mastication

Typically improves with rest

Jaw claudication is highly suggestive of GCA and is rare in other conditions, making it a valuable diagnostic clue.

4. Visual Disturbances

Vision symptoms can be subtle or sudden:

Blurred or double vision

Partial or complete loss of vision in one eye

Transient blackouts of vision (amaurosis fugax)

These signs often precede irreversible blindness. Prompt treatment can protect the second eye and prevent stroke.

5. Systemic Symptoms

Inflammation in GCA often causes generalised symptoms such as:

Low-grade fever

Unexplained fatigue

Night sweats

Loss of appetite

Weight loss

These symptoms overlap with infections and malignancies, so they must be evaluated in context.

Polymyalgia Rheumatica (PMR)

About 40–50% of individuals with giant cell arteritis also develop polymyalgia rheumatica, a related inflammatory condition that causes:

Pain and stiffness in the shoulders and hips

Difficulty raising the arms or getting out of bed

Symptoms worse in the morning and improving throughout the day

PMR can precede, accompany, or follow the onset of GCA and may respond dramatically to corticosteroid treatment.

Less Common Symptoms

While the classic features are well recognised, other symptoms may also be present:

Throat pain or discomfort when swallowing

Earache or tinnitus

Dizziness or balance issues

Tongue pain, numbness, or rarely, tongue necrosis

Chest pain or shortness of breath (if large arteries like the aorta are involved)

These signs suggest extra-cranial arterial involvement and may indicate systemic vasculitis.

Atypical Presentations

In some individuals, especially those with diabetes or pre-existing cardiovascular disease, symptoms may be subtle or atypical. Headaches may be minimal, and the first sign could be vision loss or stroke.

For this reason, doctors must maintain a high index of suspicion in older patients presenting with:

Unexplained inflammatory markers (e.g., raised ESR or CRP)

Vague symptoms like fatigue or malaise

Visual complaints, even if transient

Symptom Progression

Without treatment, symptoms of GCA usually worsen over time, with increasing inflammation and vascular damage. Once blood flow is significantly reduced, complications can set in quickly.

Vision loss from anterior ischaemic optic neuropathy (AION) can develop over hours to days, making early intervention essential.

Psychological Impact

The sudden onset of severe symptoms—especially vision problems—can cause significant anxiety and distress. Patients may experience:

Fear of going blind

Sleep disturbances

Reduced independence

Social withdrawal

Support from medical teams, counsellors, and patient support groups can make a significant difference in coping and recovery.

Summary of Key Symptoms

Symptoms of Giant Cell Arteritis

Recognising the symptoms of giant cell arteritis can help prevent permanent disability and promote faster recovery through early treatment. Anyone over 50 with new or unusual headaches, jaw pain, or visual complaints should seek urgent medical advice.

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