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Health condition · Clinically reviewed

Giant cell arteritis, an emergency where minutes count for sight and stroke.

A new headache, jaw pain on chewing or fleeting loss of vision in anyone over 50 needs same-day assessment. Steroids are started on suspicion, not on results.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSR, EULAR, NICE and MHRA sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including tocilizumab, temporal artery ultrasound and large-vessel imaging.

Key facts

Giant cell arteritis at a glance.

The essentials, in plain English: what it is, who gets it, and why treatment cannot wait for a test.

  • What it is

    A systemic large and medium vessel vasculitis, chiefly affecting the branches of the external carotid artery and increasingly the aorta and its branches.

  • Who gets it

    Almost exclusively people over 50, peak incidence after 70, with a 2 to 3:1 female to male ratio and higher rates in Northern European ancestry.

  • Emergency status

    A rheumatological emergency because untreated disease can cause sudden permanent vision loss or stroke within hours to days.

  • Overlap with PMR

    Around half of people with giant cell arteritis also have polymyalgia rheumatica, and up to a fifth of people with PMR develop GCA.

  • Foundation therapy

    High-dose oral prednisolone started immediately on clinical suspicion, without waiting for biopsy or ultrasound confirmation.

  • Steroid-sparing

    Tocilizumab, an IL-6 inhibitor, is MHRA and NICE-approved since 2018 and has changed the shape of long-term care.

Why this guide matters

A rheumatological emergency, not a headache.

The three points below shape everything that follows: recognise it early, treat on suspicion, and think beyond the temporal artery.

  • Recognise it early

    A new headache pattern in someone over 50, with jaw claudication or fleeting vision loss, is GCA until proven otherwise. Same-day rheumatology referral is standard.

  • Treat on suspicion

    High-dose prednisolone starts immediately, before biopsy or ultrasound. Waiting for results costs sight and is not acceptable practice.

  • Think large vessel too

    GCA is not only a cranial disease. Aortic and branch involvement drives long-term aneurysm risk and needs dedicated imaging and surveillance.

How the diagnosis is made

From first symptom to a clear plan.

The steps a UK rheumatology team will normally follow, in order, so you know what to expect and why.

  1. 01

    Recognising

    Urgent clinical suspicion

    New headache, scalp tenderness, jaw claudication or visual symptoms in anyone over 50 prompts same-day rheumatology referral.

  2. 02

    Recognising

    Start steroids on suspicion

    Prednisolone is started immediately, before any test, because delay costs sight. Investigations follow but do not gate treatment.

  3. 03

    Recognising

    Inflammatory markers

    ESR and CRP are typically markedly elevated, often above 50. Full blood count, liver function and albumin round out the baseline bloods.

  4. 04

    Confirming

    Temporal artery ultrasound

    A specialist musculoskeletal scan looking for the halo sign and a non-compressible artery. Increasingly the first-line imaging test in the UK.

  5. 05

    Confirming

    Temporal artery biopsy

    Ideally within two weeks of starting steroids, in a commissioned specialist service. Skip lesions mean a longer segment and bilateral sampling improve yield.

  6. 06

    Confirming

    Large-vessel imaging

    PET-CT or MR and CT angiography assess the aorta and its branches when extracranial disease is suspected or intracranial signs are absent.

  7. 07

    MDT

    Urgent ophthalmology and MDT

    Any visual symptom triggers same-day ophthalmology review. Longer term care is multidisciplinary, involving rheumatology, ophthalmology, imaging and pharmacy.

Typical timeline: from suspicion to steroids in hours, biopsy within two weeks.

Symptoms

What giant cell arteritis actually feels like.

The classic mix of headache, scalp tenderness, jaw and tongue claudication, systemic upset and, in some, sudden visual loss.

  • New-onset headache

    A new, temporal, throbbing headache in someone over 50 is the classic opening symptom and should never be dismissed as tension headache.

  • Scalp tenderness

    Pain when combing the hair, resting the head on a pillow or wearing glasses, from inflamed superficial temporal vessels.

  • Jaw claudication

    A cramping pain in the jaw on chewing that eases with rest. Considered pathognomonic and one of the strongest predictors of a positive biopsy.

  • Visual symptoms

    Transient loss of vision (amaurosis fugax), double vision or sudden permanent visual loss from anterior ischaemic optic neuropathy. Any of these is an emergency.

  • Tongue and mouth

    Tongue claudication on chewing, pallor of the tongue and, rarely, tongue or scalp necrosis in advanced disease.

  • Polymyalgia features

    Proximal muscle stiffness in the shoulders and hips, worse in the morning, with fatigue and low-grade systemic upset.

  • Systemic upset

    Low-grade fever, unintentional weight loss, malaise and night sweats. GCA is a well-recognised cause of fever of unknown origin in older adults.

  • Red flag - permanent vision loss

    Sudden painless loss of vision in one eye is a medical emergency. Steroids and admission are needed the same hour, not the next day.

Treatment

How giant cell arteritis is treated in the UK.

High-dose steroids first, tocilizumab or methotrexate where steroid burden is high, and lifelong attention to bones, blood pressure and the aorta.

  • High-dose prednisolone

    Oral prednisolone 40 to 60 mg daily is standard, with 60 to 80 mg or intravenous methylprednisolone reserved for visual involvement. Started on suspicion.

  • Structured steroid taper

    A slow, symptom and CRP-guided taper over one to two years, led by the rheumatology team. Rapid tapering risks relapse.

  • Tocilizumab (RoActemra)

    A subcutaneous weekly IL-6 inhibitor, MHRA and NICE-approved for GCA since 2018. Practice-changing after the GiACTA trial.

  • Methotrexate

    A selective steroid-sparing option in relapsing disease or where tocilizumab is unsuitable. Requires monitoring bloods.

  • Low-dose aspirin

    Aspirin 75 mg is often added for cardiovascular protection and to reduce ischaemic complications, though the evidence remains contested.

  • Gastric and bone protection

    A proton pump inhibitor for gastric cover, plus bisphosphonate, calcium and vitamin D with a baseline DEXA to protect the skeleton on long-term steroids.

  • PJP prophylaxis

    Co-trimoxazole prophylaxis is considered for prolonged high-dose corticosteroid regimens to prevent opportunistic pneumocystis pneumonia.

  • Aortic surveillance

    Annual CT or MR angiography of the aorta is arranged for people with confirmed large-vessel involvement to detect aneurysm formation early.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, rheumatologist or ophthalmologist knows your history and can tell you which parts apply to you. If in doubt about your eyes or a new headache, get seen the same day.

  • BSR. Guideline for the diagnosis and treatment of giant cell arteritis (2020).

  • EULAR. Recommendations for the management of large vessel vasculitis (2018 update).

  • NICE. Tocilizumab for treating giant cell arteritis (TA518).

  • MHRA. Corticosteroid safety alerts and monitoring guidance.

Red flags

When giant cell arteritis needs urgent attention.

Most of GCA care is planned outpatient rheumatology. These are the situations that are not and where same-day help is essential.

  • Sudden permanent vision loss

    Painless loss of vision in one eye is a same-hour emergency. Attend the eye casualty or A&E and mention suspected giant cell arteritis by name.

  • Amaurosis fugax

    Transient dimming or curtain-like loss of vision is a stroke of the eye warning. Treat as impending permanent loss until proven otherwise.

  • Diplopia in someone over 50

    New double vision with headache or scalp tenderness needs same-day rheumatology and ophthalmology assessment.

  • Jaw or tongue claudication

    Cramping pain on chewing, or tongue pallor, is a hard sign of critical arterial insufficiency and predicts biopsy-positive disease.

  • Focal neurological deficit

    Weakness, speech disturbance or brainstem symptoms in the context of GCA suggests stroke or vertebrobasilar involvement. Blue-light care.

  • Aortic pain or new murmur

    Acute chest or interscapular pain, or a new aortic regurgitation murmur, raises the possibility of aortic dissection or aneurysm.

  • Relapse during taper

    Return of headache, jaw claudication, PMR symptoms or a climbing CRP as steroids are reduced needs urgent rheumatology review before symptoms escalate.

  • Steroid harms

    New diabetes, uncontrolled hypertension, mood change, fragility fracture or opportunistic infection all warrant early specialist attention.

  • Delayed presentation

    Symptoms brushed off as migraine or tension headache for weeks. A new headache pattern after 50 is GCA until proven otherwise.

Living with it

A treatable disease, with a long taper.

Four things that make the biggest difference over the one to two years of treatment: steroid discipline, prompt reporting of visual change, bone protection and peer support.

A quiet reminder

The taper is a marathon, not a sprint.

Steady, guided steroid reduction with regular blood tests and honest reporting of symptoms is what protects both sight and long-term health.

  1. 01 Adherence

    Never stop steroids abruptly

    Prednisolone must be tapered under specialist guidance. Sudden withdrawal can trigger both disease relapse and adrenal crisis.

  2. 02 Vision

    Report visual change the same day

    Any new dimming, double vision or loss of vision needs same-day contact with the rheumatology or eye team, even years after diagnosis.

  3. 03 Bones

    Protect the skeleton

    A DEXA scan, adequate calcium and vitamin D, and a bisphosphonate where indicated protect against long-term steroid-related fracture.

  4. 04 Support

    Use patient organisations

    Vasculitis UK and PMR-GCA UK offer written material, helplines and peer support that many people find genuinely useful during a long taper.

Frequently asked

Everything we get asked about giant cell arteritis.

Quick answers on urgency, testing, steroids, tocilizumab and long-term care.

  • What is giant cell arteritis?

    Giant cell arteritis, also called temporal arteritis or cranial arteritis, is a systemic vasculitis of large and medium-sized arteries. It typically affects branches of the external carotid artery, especially the temporal arteries, and increasingly the aorta and its branches. It occurs almost exclusively in people over 50.

  • Why is it treated as an emergency?

    Untreated giant cell arteritis can cause sudden, permanent vision loss in one or both eyes from anterior ischaemic optic neuropathy or central retinal artery occlusion, as well as stroke. Once vision is lost it rarely recovers, so treatment is started on clinical suspicion within hours, before biopsy or ultrasound results are available.

  • How is giant cell arteritis diagnosed?

    Diagnosis is a clinical one, supported by markedly raised ESR and CRP, temporal artery ultrasound looking for the halo sign, temporal artery biopsy within two weeks of starting steroids, and, where extracranial disease is suspected, PET-CT or MR and CT angiography of the aorta.

  • What is the link with polymyalgia rheumatica?

    Around half of people with giant cell arteritis have polymyalgia rheumatica, and roughly one in five people with PMR develop giant cell arteritis. New headache or visual symptoms in a person with PMR needs urgent assessment and often re-treatment at GCA doses.

  • What does tocilizumab do?

    Tocilizumab is a monoclonal antibody that blocks the IL-6 receptor. Given as a weekly subcutaneous injection, it reduces relapse rates and cumulative steroid exposure. NICE recommends it for a defined period as a steroid-sparing option, following the GiACTA trial.

  • How long does treatment last?

    Most people need corticosteroids for at least one to two years, tapered slowly under rheumatology guidance. Those with relapsing or large-vessel disease may need longer treatment, adjuvant tocilizumab or methotrexate, and long-term surveillance for aortic aneurysm.

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