Giant-cell arteritis

Vision red flags: go to A&E now

• Sudden vision drop or sudden blindness, or a field curtain: go to A&E now
• Brief monocular blackout (one eye goes dark or blank, then recovers): still go to A&E now, even if vision has returned
• New double vision: go to A&E now
• Severe pain with headache and vomiting: go to A&E now (also exclude acute angle closure and other emergencies)
• If you cannot get there: call 999

What it is

Giant-cell arteritis (GCA, also called temporal arteritis) is seen almost exclusively in adults about 50 years of age or older; it is a large-vessel vasculitis. Inflammation can hit arteries that feed the optic nerve and retina and cause irreversible vision loss within a short time — for example arteritic anterior ischaemic optic neuropathy (A-AION) or central retinal artery occlusion. In plain terms: inflamed vessels can permanently damage sight quickly, so treat it as an emergency. This page is public education, not a rheumatology or ophthalmology diagnostic tool, and it does not handle booking.

Possible systemic clues (education list, not a home scorecard)

• New or changed headache (often temple or scalp)
• When eating, the jaw tires or hurts quickly and eases when you stop (clinically called jaw claudication)
• Scalp tenderness; discomfort over the temporal artery area
• Shoulder- or hip-girdle stiffness and ache, in the educational sense of polymyalgia rheumatica (PMR)
• Unexplained fatigue, feverishness, poor appetite or weight loss (non-specific)

These are education prompts for describing history at assessment — not a self-score and not a way to “rule out” GCA at home. With or without these clues, any new visual symptom still follows the emergency path.

Suspicious systemic clues without new visual symptoms

Age 50 or over with the suspicious systemic clues above (for example new headache, jaw claudication, scalp tenderness, shoulder-girdle stiffness) but no new visual symptoms yet: aim for same-day assessment by rheumatology or ophthalmology. If same-day specialty access is not possible, or any new visual symptom appears: go to A&E now. Do not start oral or topical steroids yourself.

Tests a doctor may arrange (concepts, not a DIY lab panel)

• Blood inflammation markers such as ESR and CRP — interpreted by a doctor; normal values do not fully exclude disease, and abnormal values alone are not a diagnosis
• Imaging such as temporal-artery or large-vessel ultrasound / other imaging, by specialty resources and the case
• Temporal-artery biopsy as a tissue-diagnosis concept — whether and when is a specialty decision and must not delay urgent care when sight is threatened

Treatment a specialist may discuss (classes, not a public prescription)

1. High-dose corticosteroids: intravenous versus oral is a specialty decision for vision-threatening versus other disease; this page lists no milligrams or times-daily
2. To reduce long-term steroid use, a specialist may discuss other drug classes (for example IL-6–targeted biologics). Whether they apply and whether they are registered locally is a specialty judgement
3. Infection, glucose and bone risks: specialists explain monitoring and prevention; this page is not a shopping list

Overlap with retinal artery occlusion is on the retinal vascular occlusion page.

Common questions

I have always had migraine — how is this different? Age 50 or over, a new or changed headache, jaw or scalp clues, or any new visual symptom: do not self-label it as your usual migraine; treat it as new. See the migraine and the eye page.

Systemic clues only, no new visual symptoms — still A&E? Age 50 or over with suspicious systemic clues and no new visual symptoms: same-day rheumatology or ophthalmology. If you cannot get same-day specialty care, or any visual symptom appears: go to A&E now. Do not start steroids yourself.

Brief monocular blackout that then recovers — still A&E? Yes. Even after recovery, go to A&E now.

What to say / bring to A&E? Say sudden vision drop or suspected giant-cell arteritis; when symptoms started; a list of medicines (especially steroids and anticoagulants / antiplatelets); glasses; ideally someone with you.

Carers can watch for the systemic clues above (new headache, jaw or scalp discomfort, shoulder-girdle stiffness) and help describe the history; any new visual symptom still means go to A&E now.