Temporal arteritis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 30, 2016
StartDiseasesTemporal arteritis

Temporal arteritis, also known as giant cell arteritis or cranial arteritis, is a medical condition in which there is inflammation of the temporal arteries. There are two temporal arteries, one on each side of the head, and they carry blood from the heart to the head. It is a condition that is almost always seen in patients who are over 50, and the chances of developing it increase as people age.

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Definition & Facts

Temporal arteritis falls under the more general category of vasculitis, a classification used to describe blood vessel inflammation in different parts of the body including organs and skin. These are uncommon conditions that cause damage to blood vessels by weakening, scarring or thickening them, resulting in restricted blood flow and damage to tissues and organs.

Temporal arteritis is a condition that requires prompt medical treatment because if it is left untreated, it can lead to other, more serious problems including aneurysms, blindness, stroke, or death. Temporal arteritis is very rare and affects up to 27 people over the age of 50 per 100,000 in the United States.

Symptoms & Complaints

The main symptom of temporal arteritis is a severe ongoing headache, usually felt on the sides of the head where the arteries are located. These headaches usually don't respond to over-the-counter medications.

Other symptoms may include tenderness on or around the temples, pain, and/or swelling on the top of the head, scalp tenderness or jaw pain, throat pain or tongue pain.

Jaw pain gets worse when food is being chewed. If the blood vessels have narrowed or thickened, the resulting reduced blood flow can cause general body fatigue or aching limbs.

Night sweats, depression, unexplained fever, and unexplained weight loss can also be indications of temporal arteritis, and although it is rare, occurring in under 5% of cases, a stroke may result.

Another red-flag sign can be blurred vision, double vision or distorted vision; these problems occur as a result of the decreased blood flow to the eyes, and it is extremely important to consult a physician immediately if any of these symptoms occur, since this condition can, in some cases, lead to blindness. 

Causes

The causes of temporal arteritis are not completely understood. Aging, geography, viruses, and seasonal factors and changes have all been linked to the development of temporal arteritis, but the specific connections have not been found yet.

Women are three times more likely to develop temporal arteritis than men, and the condition is more prevalent in people of Scandinavian or northern European heritage than people of other ancestries.

There are some infections that have been linked to temporal arteritis, as have massive doses of antibiotics. Researchers suspect that the condition is linked to the immune system, but this connection continues to be tested and studied. 

Diagnosis & Tests

In diagnosing this condition, the doctor will assess the patient’s descriptions of his or her symptoms and do an examination that includes exploring various alternative possibilities for those symptoms. An examination of the head will help the physician pinpoint the areas where tenderness or pain is occurring, and there are several different blood tests the doctor may order to help narrow down the specific diagnosis to temporal arteritis:

  • A blood test for hemoglobin will measure the amount of the oxygen-carrying protein in the blood.
  • A hematocrit test will measure the percentage of red blood cells in the blood.
  • An ESR (erythrocyte sedimentation rate) test is used to determine if there is inflammation present in the body. This is determined by measuring how fast red blood cells extracted from the body will collect at the bottom of a test tube in one hour’s time; a high result indicates inflammation.
  • Another test called the C-reactive protein test is also used to determine if there is inflammation in the body by measuring the amount of this liver-produced protein that is released into the bloodstream after an injury to the tissues.
  • Liver function tests will help the physician assess how well the liver is working.

A physical examination and blood tests may not be enough for a specific diagnosis, so the doctor will often schedule an outpatient procedure to perform a biopsy on the suspicious artery. Under local anesthesia, a piece of the artery is removed and sent to the lab where it will analyzed. A non-invasive ultrasound may also be performed in order to help pinpoint the diagnosis.

Treatment & Therapy

Temporal arteritis cannot be cured, but treatment for it can halt or reduce the tissue damage that results from the inadequate blood flow caused by this condition. The treating physician will often choose to begin treatment immediately without waiting for the test results. If he or she strongly suspects temporal arteritis is the problem then the more quickly the condition is treated, the less likely the patient is to develop even more severe problems.

Corticosteroids are prescribed for the initial treatment because they are highly effective in reducing the inflammation in the body. High dose steroid treatment is used until improvement is obvious, and then steroid doses will be incrementally lowered over a period of time.

Prednisone is a steroid that is used for continued treatment which usually lasts for two years. Physicians will often also recommend a daily low dose of aspirin, vitamin D supplements, and calcium supplements, weight-bearing exercise, bone density tests, and smoking cessation.

Prevention & Prophylaxis

At this time there is no known way to either predict the onset or prevent temporal arteritis from developing. That said, there are ways to alleviate the discomfort and to prevent the condition from becoming worse or causing more serious damage like heart attack, stroke, permanent nerve damage, or blindness.

All of these are problems that are likely to be prevented if treatment is started as soon as the signs of temporal arteritis are noticed, and that is the single most important reason to see a doctor immediately if any of these symptoms occur.