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Temporal arteritis

Definition

Temporal arteritis is inflammation and damage to blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck and supply the temporal area.

If the inflammation affects the arteries in your neck, upper body and arms, it is called giant cell arteritis.

Alternative Names

Arteritis - temporal; Cranial arteritis; Giant cell arteritis

Causes

Temporal, giant cell, and cranial arteritis occur when one or more arteries become inflammed, swollen, and tender.

Temporal arteritis most commonly occurs in the head, especially in the temporal arteries that branch off from a blood vessel in the neck called the carotid artery. However, the condition can affect almost any medium-to-large artery anywhere in the body.

The cause is unknown, but is believed to be partly due to a faulty immune response. The disorder has been associated with severe infections and the use of high doses of antibiotics.

The disorder may develop along with or after polymyalgia rheumatica. Giant cell arteritis is almost always seen in people over age 50, but it may sometimes occur in younger people. It is rare in people of African descent. There is some evidence that it runs in families.

Symptoms

  • Excessive sweating
  • Fever
  • General ill feeling
  • Jaw pain that comes and goes or occurs when chewing
  • Loss of appetite
  • Muscle aches
  • Pain and stiffness in the neck, upper arms, shoulder, and hips
  • Throbbing headache on one side of the head or the back of the head
  • Scalp sensitivity, tenderness when touching the scalp
  • Vision difficulties
    • Blurred vision
    • Double vision
    • Reduced vision (blindness in one or both eyes)
  • Weakness, excessive tiredness
  • Weight loss (more than 5% of total body weight)

Other symptoms that may occur with this disease:

About 40% of people will have other, nonspecific symptoms such as respiratory complaints (most frequently dry cough) or weakness or pain along many nerve areas. Rarely, paralysis of eye muscles may occur. A persistent fever may be the only symptom.

Exams and Tests

The doctor will examine your head. Touching the head may show that the scalp is sensitive and has a tender, thick artery on one side. The affected artery may have a weak pulse or no pulse.

Blood tests may include:

Blood tests cannot diagnose this condition. A biopsy and examination of tissue from the affected artery confirm the diagnosis in most cases. The biopsy is done on an outpatient basis while you are under local anesthesia.

You may also have other tests, including:

Treatment

The goal of treatment is to reduce tissue damage that may occur due to lack of blood flow.

Your doctor will likely prescribe corticosteroids taken by mouth. Corticosteroids are often started even before a biopsy confirms the diagnosis. Aspirin may also be recommended.

Most people begin to feel better within a few days after starting treatment. However, you need to take medications for 1 - 2 years. The dose of corticosteroids is slowly reduced.

Taking corticosteroid medications for this long can make bones thinner and increase the chance of a fracture. As a result, the following should be started right away:

  • Avoid smoking and excess alcohol intake
  • Take extra calcium and vitamin D (based on your health care provider's advice)
  • Start walking or other doing weight-bearing exercises
  • Monitor the bones using a bone mineral density (BMD) test or DEXA scan

Other medications that suppress the immune system are sometimes needed.

Outlook (Prognosis)

Most people make a full recovery, but long-term treatment (for 1 to 2 years or longer) may be needed. The condition may return at a later date.

Possible Complications

Possible complications, especially if the condition is not treated properly or promptly, include:

  • Damage to other blood vessels in the body
  • Development of aneurysms (ballooning of blood vessels) in patients with giant cell arteritis
  • Sudden vision loss or eye muscle weakness
  • TIA or stroke

Side effects from steroid or immune-suppressing medications may also occur.

When to Contact a Medical Professional

Call your health care provider if you have a persistent throbbing headache and other symptoms of temporal arteritis.

Prevention

There is no known prevention.

References

Hellmann DB. Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In: Firestein GS, Budd RC, Harris ED Jr., et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 81.


Review Date: 1/26/2011
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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