Report on Giant Cell Arteritis: A Healthcare Perspective

This report provides a comprehensive overview of Giant Cell Arteritis (GCA), also known as temporal arteritis, an inflammatory disease primarily affecting large blood vessels in individuals over 50. It details the incidence, risk factors (age, sex, autoimmune diseases, and genetics), and pathophysiology, highlighting the role of immune responses involving T-cells and cytokines. The report explores treatment options, including corticosteroids, immune-suppressing drugs (like methotrexate), and the novel drug tocilizumab. Patient education is emphasized, focusing on lifestyle adjustments and awareness of symptoms. References to key research articles support the information presented. The report aims to enhance understanding of GCA's impact and management.

Running head: GIANT CELL ARTERITIS
GIANT CELL ARTERITIS
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Introduction
Giant cell arteritis (GCA) is also known as temporal arteritis, which is defined as the
condition of inflammatory disease primarily affecting the blood vessels (large) of neck, arms
and scalp. The inflammation leads to blockage or narrowing of blood vessels that interrupts
the blood flow and is generally associated with the condition of polymyalgia rheumatica.
Giant cell arthritis (GCA) primarily affects the individuals who are more than 50 years of age
and the incidence rate rises with increasing age (Buttgereit et al., 2016). The incidence rate
reported in the South Australia is relatively low as compared to New Zealand, exhibiting 3.2
per 100,000 people in Australia. The prevalence rate of temporal arteritis is poorly reported
all over the world. In Australia, 1.23% of population who aged more than 65 years have
reported the condition of GCA, 3.5% of the population have reported the condition of GCA
associated with Polymyalgia rheumatica (PMR) (Yates et al., 2016). There are different types
of risk factors that is responsible for causing the condition of giant cell arteritis among which
age and sex is the major factor. It is established that females are more prevalent to experience
the health issue of GCA as compared to male. The other risk factors includes autoimmune
disease , where the immune system of the individual body affects the blood vessels and
develop the condition of GCA, environmental and genetic factors like infection is also
responsible for causing Giant cell arteritis (Hoffman, 2016).
Pathophysiology
GCA is considered as an immune-facilitated chronic inflammatory illness affecting
the large vessels. The pathophysiology of Giant cell arthritis is poorly assumed, whereas the
epidemiology related to GCA strongly directs that ageing, genetic background and gender are
primarily responsible for triggering the condition of GCA. Numerous polymorphisms is being
considered to be related with amplified risk of obtaining GCA among older people but the
strongest relation of CGA, which is majorly responsible for triggering the condition of CGA

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belonged to the variants of class II major histocompatibility complex supporting the idea that
GCA is considered as the antigen-determined disease (Watanabe et al., 2016). Though, the
activity of triggering agents is not yet identified bit it is evident that stimulated dendritic cells
are existent in the lesions and therefore play a crucial role in activating the T-cells. Giant Cell
Arthritis is categorized by the projecting Th1-mediated immune reaction associated with
dynamic manifestation of IFNγ and IFNγ-prompted goods in injuries within the accordance
of granulomatous mode of lesions. Hence, it is clearly evident and has become more apparent
in the recent years that Th17-facilitated immune response majorly contributes towards the
initiation of GCA condition (Al-Mousawi et al., 2019).
GCA result in inflammation of medium or large blood vessels that activate the
dendritic cells within the arterial walls and result in the production of chemokines. This
chemokine production recruits the CD4+ T cells and the macrophages, which therefore
activates the CD4+ T cells and result in the formation of granulomatous infiltrates (Conway
et al., 2018). The activated CD4+ T cells therefore secrets the cytokines IFNγ and the
macrophages leads to the production of interleukins namely IL-1, Il-16, ROs and
metalloproteinase that is eventually responsible for triggering the onset of Giant cell arteritis
condition by remodelling the vessels wall and resulting in initial hyperplasia among the older
population, which further leads to the condition of giant cell arteritis (GCA). Hence, it is
clearly understood that the T cells are altered which is majorly responsible for regulating the
immune system of an individual and hence, the immune system are weakened that in turn
affects the normal homeostasis balance in the patient who is exhibiting the condition of giant
cell arteritis (Brault et al., 2018).
Treatment
The quick treatment method of giant cell arteritis (GCA) includes consumption of
corticosteroids, which is mainly consumed as high doses. Corticosteroid can be consumed

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either orally ort through intravenously for reducing the risk of CGA, as corticosteroids will
reduce the risk of visual defects in the individual suffering from health illness of GCA. Oral
glucocorticoids are used mainly oral prednisone for treating the condition of CGA. The
individual suffering from GCA might have to consume drug for a longer period of time that
will aim to reduce the severe level of inflammation (Arthritis Foundation, 2019).
Consumption of corticosteroid result in some serious side-effects such as muscle weakness or
high blood pressure, hence, to counter the above mentioned side-effects the healthcare
professional will provide vitamin D and calcium supplements that will help the patient to
overcome the side-effects of corticosteroid drugs (Rovensky, 2017). Immune-suppressing
drugs are also used to treat the condition of GCA namely methotrexate, which will strengthen
the immune system of the individual and inhibit the production macrophages that will trigger
the condition of hyperplasia that ultimately result in temporal arteritis. The Food and Drug
Administration (FDA), have approved a novel drug named tocilizumab to treat the condition
of giant cell arteritis. This drug will reduce the symptom of the condition and also aim to
decrease the arterial inflammation which is majorly accountable for GCA (Food and Drug
Administration, 2019).
Patient education
Giant cell arteritis majorly affects the older population and hence while nursing the
patient it is very important for the healthcare professionals to educate the patient regarding
the health condition and the increase their awareness regarding the symptoms that will affect
the health condition. This will help the patient to gain relevant knowledge regarding
managing their lifestyle and adopt the suitable behavioural changes that will reduce the
incidence of GCA. In the key patient education, the nurse will also educate the patient to not
smoke and adapt a healthy living lifestyle that will aim to manage the health condition. In the
nursing education, the nurse will also explain the patient regarding the diagnosis of GCA and

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what kind of medication will be effective in managing their health (Lazarewicz & Watson,
2019).
Conclusion
It can concluded that Giant cell arteritis is the health issue that majorly affects the
older population and alter their immune system and homeostatic balance. The treatment
option is also elaborated in this study, stating the corticosteroid treatment is the best treatment
option that will help the patient to reduce the risk of GCA.

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References
Al-Mousawi, A. Z., Gurney, S. P., Lorenzi, A. R., Pohl, U., Dayan, M., & Mollan, S. P.
(2019). Reviewing the pathophysiology behind the advances in the management of
giant cell arteritis. Ophthalmology and therapy, 8(2), 177-193.
Arthritis Foundation. (2019). Giant Cell Arteritis | Arthritis Foundation. Retrieved 9
September 2019, from https://www.arthritis.org/about-arthritis/types/giant-cell-
arteritis/
Brault, C., Riis, A. H., Mor, A., Duhaut, P., & Thomsen, R. W. (2018). Does low risk of
infections as a marker of effective immunity predict increased risk of subsequent giant
cell arteritis or polymyalgia rheumatica? a Danish population-based case–control
study. Clinical epidemiology, 10, 1533.
Buttgereit, F., Dejaco, C., Matteson, E. L., & Dasgupta, B. (2016). Polymyalgia rheumatica
and giant cell arteritis: a systematic review. Jama, 315(22), 2442-2458.
Conway, R., O’neill, L., McCarthy, G. M., Murphy, C. C., Fabre, A., Kennedy, S., ... &
Molloy, E. S. (2018). Interleukin 12 and interleukin 23 play key pathogenic roles in
inflammatory and proliferative pathways in giant cell arteritis. Annals of the
rheumatic diseases, 77(12), 1815-1824.
Food and Drug Administration. (2019). U.S. Food and Drug Administration. Retrieved 9
September 2019, from https://www.fda.gov/news-events/press-announcements/fda-
approves-first-drug-specifically-treat-giant-cell-arteritis
Hoffman, G. S. (2016). Giant cell arteritis. Annals of internal medicine, 165(9), ITC65-
ITC80.
Lazarewicz, K., & Watson, P. (2019). Giant cell arteritis. bmj, 365, l1964.
Rovenský, J. (2017). Giant-Cell Arteritis. In Polymyalgia Rheumatica and Giant Cell
Arteritis (pp. 201-208). Springer, Cham.

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Watanabe, R., Goronzy, J. J., Berry, G., Liao, Y. J., & Weyand, C. M. (2016). Giant cell
arteritis: from pathogenesis to therapeutic management. Current treatment options in
rheumatology, 2(2), 126-137.
Yates, M., Graham, K., Watts, R. A., & MacGregor, A. J. (2016). The prevalence of giant
cell arteritis and polymyalgia rheumatica in a UK primary care population. BMC
musculoskeletal disorders, 17(1), 285.