Temporal Arteritis

Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition affecting the medium-sized blood vessels that supply the head, eyes, and optic nerves.

Giant cell arteritis (GCA) is a systemic vasculitis of large and medium arteries that usually, though not exclusively, involves the temporal artery. The diagnosis should be considered in every patient over the age of 50 with headache. This is one cause of headache in which a laboratory test-the erythrocyte sedimentation rate-is quite useful in increasing or decreasing the likelihood of the diagnosis, although false positive and negative ESR results do occur. GCA is frequently associated with polymyalgia rheumatica (PMR).

Causes

Temporal Arteritis disease is one of a group of diseases in which the linings of large- or medium-sized blood vessels become inflamed. The elastic layer of these vessels is attacked by "giant" cells and chemicals produced by the immune system. This reaction reduces blood flow through the blood vessels, and the limited blood supply causes the symptoms.

Symptoms

• Headache ++++: unilateral temporal ++, nontemporal (>30%)
• Jaw claudication and facial pain +++
• Decreased visual acuity, sudden loss of vision
• Constitutional symptoms (malaise, weight loss)
• Muscle pain and stiffness ++: large proximal muscle groups, since may have PMR
• Visual disturbances +++ : including diplopia, visual field defect

Signs

• Scalp tenderness +++
• Abnormal palpable temporal artery +++: nonpulsatile, cordlike, nodular, tender
• Fever ++
• Cranial nerve palsy ++: diplopia, ptosis, rarely deafness
• Funduscopy: may reveal ischemic changes if retinal artery occlusion

Treatment

The goal of treatment is to minimize irreversible tissue damage that may occur because of lack of blood flow (ischemia). The primary treatment for the disease is oral steroid medication to reduce the inflammatory process.  Most patients notice an improvement in their symptoms within several days.  In some cases, a long-term maintenance dosage of the steroid is required.   

Prevention

There is no medically proven approach to prevention.