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 | What is giant cell arteritis? |
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Arteritis means inflammation of the arteries and it is one of those conditions in which the body's own immune system appears to 'attack' it's own tissues, in this case the lining of the arteries of the body. These are collectively called autoimmune diseases. When examined under the microscope, the inflamed artery will be seen to contain increased numbers of a specialised type of cell of the immune system, the 'giant cell', which gives this condition it's name.
Giant cell arteritis (GCA) is considered to be a condition within the spectrum of the more general condition called polymyalgia rheumatica (PMR) - of which giant cell arteritis is the more severe form of the illness. The two entities may occasionally occur together in the same patient, up to 33 per cent of patients with PMR may have evidence of GCA on temporal artery biopsy.
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| What causes it? |
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The cause of GCA is unknown. There is damage to the particular lining of the arterial wall (called 'internal elastic lamina', but other layers are also involved). This may be partly due to the ageing process, but there is probably also a genetic element that is not yet well defined. Certain markers in blood cells called HLA antigens are found more commonly in GCA patients than the unaffected population, which is a clue to the genetic link. Highly stressful events such as a recent bereavement occasionally trigger the illness.
Abnormal immune responses occur both in blood and at cell level. Inflammation of the blood vessels is caused by the local deposition of immune complexes - protein compounds formed by the combination of antigen (the trigger to the immune system) and antibody (the immune system's response). Immune complexes have powerful effects on a range of other chemical reactions within the body, and are involved in many autoimmune diseases.
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| What are the symptoms of GCA? |
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Patients notice symptoms rather suddenly and, in two thirds of cases, experience headaches (often burning or sharp, stabbing pains) that can be severe and are felt mainly over the temple area but can be at other regions, for example, at the back of the head.
Other common symptoms include:
 fever
night sweats
difficulty in chewing firm food, with pain and aching in the jaws (called jaw claudication) this can affect two thirds of people.
Less common symptoms are:
visual complaints such as double vision, haziness or sudden painless loss of sight, which affects 6 to 10 per cent of people with GCA. The threat of visual loss is the most serious aspect of GCA and underlines the need to make an accurate diagnosis and treat the condition quickly and effectively.
visual loss can appear after several weeks or months of the other complaints, initially perhaps on one side but the other eye can also be affected within days. Permanent visual loss occurs in up to 20 per cent of this group of people.
tingling on the tongue and loss of taste.
patients often feel that the arteries on the temple area are swollen and painful to touch, which makes brushing of the hair often rather difficult.
The symptoms are wide ranging depending on the site where the arteries are involved. In contrast to other forms of vasculitis, GCA rarely affects the lungs, kidneys or the skin - in which case nodules on the skin and dark spots may appear.
Quite often people suffer from complaints similar to those of polymyalgia, which include:
abrupt aching and stiffness across the neck and shoulders, upper arms and around the hip girdles.
low mood.
lethargy.
lack of appetite and weight loss.
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