Temporal arteritis is a condition in which the temporal arteries supplying blood to the head and brain become inflamed or damaged. Temporal arteritis is also known as cranial arteritis or giant cell arteritis. Giant cell arteritis (GCA) is a segmental systemic granulomatous arteritis affecting medium and large arteries in individuals >50 yr. The inflammation primarily targets branches of the extracranial head and neck blood vessels (external carotids, temporal arteries, ciliary and ophthalmic arteries). The aorta and subclavian and brachial arteries can also be affected. Intracranial arteritis is rare (Ferri, 2018).
There are approximately 20 new cases of temporal arteritis for every 100,000 people over 50 years of age. Incidence increases with age with the highest rate being among those 70-79 years old, is more common in women than in men by 3:1 and is more often seen in Caucasians than any other race (Petri, Nevitt, Sarsour, Napalkov, and Collinson, 2015). There are no estimates of the prevalence of GCA in the United States population in the current millennium. Most cases are paired with a diagnosis of polymyalgia rheumatic (PMR).
Pathophysiology
Per Mayo Clinic (2015), the most common symptoms of giant cell arteritis are head pain and tenderness, which is often severe and usually affects both temples. The onset of the condition can feel like the flu.
Generally, signs and symptoms of giant cell arteritis include:
•Persistent, severe head pain, usually in your temple area
•Scalp tenderness
•Jaw pain when you chew or open your mouth wide
•Fever
•Fatigue
•Unintended weight loss
•Vision loss or double vision, particularly in people who also have jaw pain
•Sudden, permanent loss of vision in one eye
Physical Assessment and Examination
Diagnosis can be rather difficult, as many of the early signs of this disease are common in many other conditions. Generally, providers will first rule out other causes. The provider will complete a thorough physical examination, focusing on the temporal arteries. The arteries may be tender upon palpation and have a cord-like appearance. The provider may order laboratory testing including erythrocyte sedimentation rate and a c-reactive protein which are general indicators of inflammation in the body. Follow-up comparison of these lab results may indicate progress of treatment. Mayo Clinic (2015) states that biopsy is the best way to confirm a diagnosis of giant cell arteritis. A small sample of the temporal artery is taken and may show inflammation that includes abnormally large cells, called giant cells. It is still possible to have a negative biopsy in which case a biopsy would be performed on the other side of the patient’s head. Other diagnostic imaging may also include MRA, Doppler and PET scan.
Treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.
The patient will feel better within just a few days of beginning treatment. The patient may need to continue taking medication for one to two years or longer; the lowest dose of corticosteroids needed to control inflammation. Some symptoms, particularly headache, may return during this tapering period. The patient should also be educated as to the risks and side effects of treatment with corticosteroids. It is important to educate patient related to lifestyle changes including a healthy diet, exercise, check-ups and the use of aspirin to reduce the risk of blindness and stroke (Mayo Clinic, 2015).
Serious visual complications including blindness, may occur in 10 to 15 percent of patients if untreated or inadequately treated. Patients will often be referred to an ophthalmologist, neurologist or rheumatologist based on the symptom presentation. Patients will follow-up with their provider and all specialists as needed until the symptoms have resolved or optimally managed.
References
Crowson, C. S. and Matteson, E. L. (2016). Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. American Journal of Rheumatology. Retrieved from http://acrabstracts.org/abstract/contemporary-prevalence-estimates-for-giant-cell-arteritis-and-polymyalgia-rheumatica-2015/
Ferri, F.F. (2017). 2018 Ferri’s clinical advisor: 5 books in one. Amsterdam: Elsevier.
Mayo Clinic. (2015). Giant cell arteritis. Retrieved from https://www.mayoclinic.org/diseases-conditions/giant-cell-arteritis/symptoms-causes/syc-20372758
Petri, H., Nevitt, A., Sarsour, K., Napalkov, P. and Collinson, N. (2015). Incidence of giant cell arteritis and characteristics of patients: Data-driven analysis of comorbidities. Arthritis Care and Research. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/acr.22429/full
