The conditions known as Giant Cell Arteritis and Polymyalgia Rheumatica may occur in people who are more than 50 years of age. They are inflammatory conditions that are more commonly found in women between the ages of 70 and 80. People belonging to the Caucasian race are more likely to get them compared to other races.
It has been observed that 50% of the people who have giant cell arthritis also have polymyalgia rheumatica, and 10% to 20% of people with polymyalgia rheumatica have giant cell arthritis. They can both occur at the same time or one after the other.
About Giant Cell Arteritis
The chronic inflammation or swelling of large arteries of the upper body, neck, and head is called giant cell arteritis (GCA). The arteries that are above, in front of the ears, and on both sides of the head (temple) are generally affected, which is also called cranial arteritis or temporal arteritis. It is generally found in people over 50 years of age in North American and European countries.
Giant cell arthritis is characterized by symptoms like pain in one or both temples and a severe headache. This happens when the large arteries in the head are affected. While brushing one’s hair, pain can also be experienced. While chewing food, one can experience pain in the jaws. Pain can be experienced in the tongue while speaking or eating. There is a loss of vision or double vision. Permanent blindness can occur if the blood supply to the optic nerve is blocked. The neck and arms can be stiff and painful. There can be unintentional weight loss as well. If the blood supply to the brain gets blocked, then there is a chance for a lethal brain stroke. Due to inflammation, damage can occur to the aorta (the large vessel supplying the heart), leading to a bulge or aneurysm formation in the wall.
The diagnostic criteria for giant cell arthritis have been developed by the American College of Rheumatology. At least 3 criteria out of 5 must be met to confirm it as giant cell arteritis. The criteria include:
- The age of the patient must be 50 years or more
- Tenderness or pain of the temporal artery (artery supplying both sides of the head) or decrease in the pulse of temporal artery
- Localized headache
- The erythrocyte sedimentation rate should be 50 mm per hour or more
- The temporal artery biopsy should be normal
In the biopsy procedure, a small sample of the temporal artery is taken and viewed under the microscope to check for any abnormalities. The doctor also conducts blood tests to rule out any other medical conditions and to check for inflammation of the arteries.
About Polymyalgia Rheumatica
Polymyalgia rheumatica (PMR) is a condition in which the muscles of the shoulders, neck, thigh, and hips become inflamed and stiff. It is seen to occur more in women over 50 years of age.
There is pain and stiffness in the muscles of the neck, shoulders, thighs, and hips, along with weakness, fever, fatigue, and unintended weight loss. These symptoms may develop suddenly. Initially, it is unilateral (occurring only on one side), and gradually, it becomes bilateral as the pain progresses. On physical examination, there can be peripheral edema (fluid retention), swelling of the hands and feet, and synovitis (swelling of synovial joint).
The doctor may perform a complete physical examination and take note of the symptoms. A blood test will be done to check the blood count and inflammation of the arteries. A slightly elevated ESR (erythrocyte sedimentation rate) is seen. A muscle biopsy may be done to check for polymyalgia rheumatica.
Treatment of Giant Cell Arteritis and Polymyalgia Rheumatica
Medications like non-steroidal anti-inflammatory drugs (NSAIDS) are not helpful in treating cases of giant cell arteritis, whereas they are used to treat mild cases of polymyalgia rheumatica. The doctor would prescribe over-the-counter NSAIDS like Ibuprofen (Motrin, Advil), aspirin, and naproxen to treat polymyalgia rheumatica. To treat giant cell arthritis and severe cases of polymyalgia rheumatica, corticosteroids are prescribed in oral pill form, which has to be taken for nearly 2 years. For polymyalgia rheumatica, a low dosage of prednisone (10mg to 20 mg per day) is prescribed, whereas for giant cell arteritis, high doses (40 mg to 60 mg per day) of prednisone is given. The side effects you need to look out for in corticosteroid therapy are an increase in blood pressure, weak bones, an increase in blood sugar level, osteoporosis (loss of bone density), a high cholesterol level, cataracts (clouding of eye lens), and depression.
Giant cell arteritis and polymyalgia rheumatica have been found to occur due to aging and a weak immune system. To prevent these conditions, one must develop a healthy lifestyle that consists of eating healthy foods like fresh vegetables, whole grains, fruits, low-fat meat, low-fat dairy products, and exercising regularly.