Temporal Arteritis
A serious disease characterized by inflammation of the walls of the blood vessels. The
vessels affected by inflammation are the arteries (hence the name "arteritis").
The age of affected patients is usually over 50 years of age. Temporal arteritis is also
known as temporal arteritis and as giant cell arteritis. It can lead to blindness and/or
stroke. The disease is detected by a biopsy of an artery. It is treated with high dose
cortisone-related medications.
General information about Temporal Arteritis
Temporal arteritis almost always occurs in people over 50, and it becomes more common
as people age. About 20 out of 100,000 people over the age of 50 suffer from temporal
arteritis. Women are affected twice as often as men. Some authorities say that temporal
arteritis is more common in Caucasians (especially Scandinavians) than in people of other
races. Close relatives of patients with temporal arteritis may be more likely than others
to get the disease.
Patients with Temporal arteritis are diagnosed and overlap with a broader disorder
called giant cell arteritis. This can affect parts of the body in addition to the scalp,
eyes, and jaw. Sometimes the disease can cause restricted circulation to both arms or both
legs, producing pain in the affected limbs. With other blood vessels involved, patients
with advanced forms of the disease may experience strokes or transient ischemic attacks
(TIA). These result in brief episodes of pain caused by decreased blood flow. Even heart
attacks are occasionally caused by giant cell arteritis.
Causes of Temporal Arteritis
Giant cell, Cranial, or temporal arteritis occurs when there is inflammation and
necrosis one or more arteries. It most commonly occurs in the head, especially in the
temporal arteries that branch from the carotid artery of the neck. However, it can be
systemic, affecting multiple medium-to-large sized arteries anywhere in the body.
The cause is unknown but is assumed to be, at least in part, an effect of the immune
response. The disorder has been associated with severe infections and high doses of
antibiotics. The symptoms occur because of inflammation.
The disorder may exist independently or may coexist with or follow polymyalgia rheumatica (a disorder
characterized by abrupt development of pain and stiffness in the pelvis and shoulder
muscles). About 25% of people with giant cell arteritis also experience polymyalgia
rheumatica.
Giant cell arteritis is seen almost exclusively in those over 50 years old, but may
occasionally occur in younger people. It is rare in people of African descent. There is
some evidence that it runs in families.
Symptoms of Temporal Arteritis
- fever
- a throbbing headache on one side of the head or the back of the head
- scalp sensitivity, tenderness when touching the scalp
- jaw pain, intermittent or when chewing
- vision difficulties
- blurred vision, double vision
- reduced vision, blindness in one or both eyes
- weakness, excessive tiredness
- a general ill feeling
- a loss of appetite
- weight loss (more than 5% of total body weight)
- muscle aches
- excessive sweating
Diagnosis of Temporal Arteritis
Doctors from a number of specialties develop experience in diagnosing and treating
Temporal arteritis. These include internists, who treat a broad range of diseases;
rheumatologists, who focus on rheumatic diseases; geriatricians, who treat older people;
ophthalmologists, who treat eye and vision disorders; neurologists, who treat headaches
and problems of the optic nerve; and vascular surgeons, who treat blood vessel problems.
The doctor will generally take a medical history first. The patient can help the doctor
tremendously by reviewing all symptoms--both major and minor--from the last two or three
months. If possible, the patient should ask family or close friends for help in recalling
his/her ailments from recent months. Then the doctor will conduct a complete physical
examination. Often, he or she will detect a tender, swollen artery on the scalp.
The doctor will order blood tests as well. A standard and inexpensive test called the
erythrocyte sedimentation rate (ESR or "sed" rate) is particularly helpful.
Results from this test, which measures inflammation in the body, will almost always be
higher than normal. Tests of the red blood cells may show mild anemia. Sometimes blood
tests for liver function will also be abnormal.
The definitive diagnostic test is a temporal artery biopsy. A doctor will make one or
more tiny incisions under local anesthesia to remove samples of the suspect artery. Under
the microscope, a pathologist usually can identify the typical damage caused by temporal
arteritis.
Treatment of Temporal Arteritis
The goal of treatment is to minimize irreversible tissue damage
that may occur because of lack of blood flow.
The mainstay of treatment is a course of corticosteroids (steroid hormones that have an
anti- inflammatory effect), usually prednisone. The initial prescription involves a fairly
high dose of steroids (40-60 mg/day) which is gradually tapered down to a maintenance
dose. Because of the high incidence of blindness in untreated cases, steroid therapy
should be started immediately rather than waiting for biopsy results. Patients typically
take this maintenance dose for periods of one to three years. Sometimes nonsteroidal
anti-inflammatory drugs (NSAIDs) are prescribed for muscle aches or headaches, especially
while steroid doses are being reduced.
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