Giant Cell Arteritis

Unmasking the medical master of disguise

It is an incredibly protean disease – it can present in so many different ways.
Dr John Stone Director of Clinical Rheumatology at Massachusetts General Hospital, USA.

Living with GCA

Patients Cheryl, Richard, Judith and David and expert Dr John Stone on living with giant cell arteritis (GCA)

Proteus – from where the word protean derives – was the mythological master of disguise. GCA is a protean, “stealth” condition, still confounding the medical community almost 130 years after it was first documented.

GCA can trigger inflammation inside a number of different arteries in the body. This means it reveals itself in different ways in different people, causing a complex range of symptoms – from headaches and jaw pain to scalp tenderness.1 This is also why it is typically diagnosed by one of a range of medical professionals – from rheumatologists, neurologists and ophthalmologists to general practitioners. It is this range of ambiguous symptoms that means it is often misdiagnosed, or diagnosed late.1

Missing the warning signs can have a devastating impact on a patient’s life, including permanent sight loss.1 Despite the urgency to treat GCA, it is not usually until it is too late that a patient’s individual symptoms get pieced together.

I had to visit a whole bunch of specialists, who all tried hard, but this was very strange to them – it was clear that something was wrong.
A German patient on living with GCA

Common Symptoms

It is vital that people know what to look for so they get a GCA diagnosis as soon as possible. Guidance from the UK’s National Institute of Health and Care Excellence (NICE) sets out GCA’s most common symptoms that help people to “Think GCA”:1,10

Severe headaches
Jaw pain
Scalp tenderness
Visual problems
Weight loss

Anyone with those symptoms should be treated as a medical emergency and started on immediate steroid treatment to reduce inflammation and prevent arterial blood supply becoming blocked. Further tests will then be done to confirm the diagnosis.1

There is too often a delay in diagnosis, and a delay in diagnosis means occurrence of disease complications before we can even begin to treat patients.
Dr John Stone Director of Clinical Rheumatology at Massachusetts General Hospital, USA.


  • 1. Bhat S, et al. Giant cell arteritis. Midlife and Beyond, GM. Rheumatology. 2010; 071-079.
  • 2. Ponte C, et al. Giant cell arteritis: Current treatment and management. World J Clin Cases, 2015; 3(6): 484-494.
  • 3. Hunder G. History of giant cell arteritis (GCA) polymyalgia rheumatic (PMR). Rheumatology. 2005; 44(suppl 3):iii1.
  • 4. Hunder G et al. The American College of Rheumatology 1990 Criteria for the Classification of Giant Cell Arteritis. Arthritis & Rheum. 1990; 33(8):1122-1128.
  • 5. Salvarani C., et al. Laboratory investigations useful in giant cell arteritis and Takayasu’s arteritis. Clin Exp Rheumatol 2003; 21(Suppl. 32):S23-S28.
  • 6. Chatterjee S., et al. Clinical Diagnosis and Management of Large Vessel Vasculitis: Giant Cell Arteritis. Curr Cardiol Rep (2014) 16:498. DOI 10.1007/s11886-014- 0498-z.
  • 7. Mazlumzadeh M., et al. Treatment of giant cell arteritis using induction therapy with high-dose glucocorticoids: a double-blind, placebo-controlled, randomized prospective clinical trial. Arthritis Rheum. 2006;54(10):3310-8.
  • 8. Villiger P., et al. Tocilizumab for induction and maintenance of remission in giant cell arteritis: a phase 2, randomised, double-blind, placebo-controlled trial. The Lancet. Published online 4 March 2016.
  • 9. GCA pathophysiology. BMJ best practice. [Internet; cited 2017 Nov 7]. Available at:
  • 10. Giant cell arteritis. NICE CKS. [Internet; cited 2017 Nov 7]. Available at:!scenario.