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Temporal Arteritis

(Giant Cell Arteritis)

Definition

Temporal arteritis is a condition of inflammation of the arteries. It affects the head, neck, upper body, and arms. The temporal artery is most often affected. It runs over the temple, to the outside of the eye. In extreme or untreated cases, this condition can lead to blindness or strokes. Two other terms often associated with this condition include:

Giant cell arteritis (GCA)—another name for temporal arteritis

Vasculitis—a general term for swelling or inflammation of blood vessels

Temporal Arteritis

Causes

The cause of temporal arteritis is not known. It may result from an immune response in the body.

Risk Factors

Factors that increase your risk of temporal arteritis include:

Age: 50 or older

Race: White, especially of Scandinavian or northern European descent

Location: northern latitudes

Sex: female

Family member with temporal arteritis

Polymyalgia rheumatica , a condition characterized by stiffness and pain in muscles of the neck, shoulders, lower back, hips, and thighs

Smoking and low body weight

Symptoms

Symptoms may include:

Headaches that are usually localized and one-sided

Fever or flu -like symptoms

Pain when chewing

Pain in the jaw or tongue

Scalp pain or tenderness over the temporal artery

Anemia

Fatigue

Loss of appetite and weight loss

Vision loss

Sweats

Aches in the joints or muscles

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Diagnosis is based on the occurrence of certain factors, including:

Age: 50 or older

New localized headache

Temporal artery tenderness or decreased temporal artery pulse

Sedimentation rate of 50 mm/hour or greater

Abnormal temporal artery biopsy

Anemia

Tests may include:

Blood tests, including a sedimentation rate, c-reactive protein, hemoglobin, or hematocrit

Biopsy —removal of a sample of the temporal artery for testing

Retinal exam

Ultrasound of the temporal artery

Treatment

Treatment may include:

Corticosteroid Therapy

This therapy is used to decrease the swelling and inflammation. It will also help decrease the risk of blindness. At first, high doses of prednisone are often given. The doses are then tapered off. Therapy is often continued for several years.

Long-term use of corticosteroids has some harmful side effects. This may include:

Osteoporosis —weakening of bones

Diabetes —high glucose levels in blood

Cataracts —clouding of the eye's lens

Stomach irritation

Supplements will help to stop these effects on the bone. The supplements may include:

Calcium

Vitamin D

Bisphosphonate

Low-Dose Aspirin

Your doctor may recommend that you take low-dose aspirin every day. This may help to reduce the risk of vision loss associated with temporal arteritis.

Prevention

There is no known way to prevent temporal arteritis.

RESOURCES:

American Academy of Family Physicians

http://www.aafp.org/

Arthritis Foundation

http://www.arthritis.org/

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov/

CANADIAN RESOURCES:

Canadian Cardiovascular Society

http://www.ccs.ca/

Canadian Society of Otolaryngology

http://www.entcanada.org/

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org .

Karahaliou M, Vaiopoulos G, Papspyrou S. Colour duplex sonography of temporal arteries before decision for biopsy: a prospective study in 55 patients with suspected giant cell arteritis. Arthritis Res Ther. 2006;8:R116.

Larsson K, Mellström D, Nordborg C, Odén A, Nordborg E. Early menopause, low body mass index, and smoking are independent risk factors for developing giant cell arteritis. Ann Rheum Dis. 2006;65:529-532.

Lawrence RC, Helmick CG, Arnett FC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998; 41:778.

Nat Clin Pract Rheumatol . 2006;2:443-451.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov .

Parikh M, Miller NR, Lee AG, et al. Prevalence of a normal c-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology . 2006;113(10):1842-1845.

Smetana GW, Shmerling RH. Does this patient have temporal arteritis? JAMA. 2002; 287:92.

Temporal arteritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 2009. Accessed February 10, 2010.

University of Southern California Department of Neurosurgery website. Available at: http://archsurg.ama-assn.org/cgi/content/full/139/11/1146 .

Last reviewed September 2012 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.