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Temporal arteritis

Arteritis - temporal; Cranial arteritis; Giant cell arteritis

 

Temporal arteritisis inflammation and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It is also called giant cell arteritis.

Causes

 

Temporal arteritis affects medium-to-large arteries. It causes inflammation, swelling, tenderness, and damage to the blood vessels that supply blood to the head, neck, upper body and arms. It most commonly occurs in the arteries around the temples (temporal arteries) that branch off from the carotid artery in the neck. In some cases, the condition can occur in medium-to-large arteries in other places in the body as well.

The cause of the condition is unknown. It is believed to be due in part to a faulty immune response . The disorder has been linked to some infections and to certain genes.

The problem may develop with or following another inflammatory disorder known as polymyalgia rheumatica . Giant cell arteritis almost always occurs in people over age 50. It is most common in people of northern European descent. The condition may run in families.

 

Symptoms

 

Some common symptoms of this problem are:

  • Throbbing headache on one side of the head or the back of the head
  • Tenderness when touching the scalp

Other symptoms may include:

  • Fever
  • General ill feeling
  • Jaw pain that occurs when chewing
  • Pain in the arm after using it
  • Muscle aches
  • Pain and stiffness in the neck, upper arms, shoulder, and hips
  • Weakness, excessive tiredness

Problems with eyesight may occur, and at times may begin suddenly. These problems include:

  • Blurred vision
  • Double vision
  • Reduced vision (blindness in one or both eyes)

Other symptoms may occur with this disease, including:

  • Cough
  • Tongue or throat pain
  • Hearing loss
  • Joint stiffness

 

Exams and Tests

 

The health care provider will examine your head.

  • The scalp is often sensitive to touch
  • There may be a tender, thick artery on one side of the head, most often over one or both temples.

Blood tests may include:

  • Hemoglobin or hematocrit
  • Liver function tests
  • Sedimentation rate (ESR) and C-reactive protein

Blood tests alone cannot provide a diagnosis. You will need to have a biopsy (tissue sample) from the involved artery.

You may also have other tests, including:

  • Duplex ultrasound
  • MRI
  • PET scan

 

Treatment

 

Getting prompt treatment can help prevent severe problems such as blindness or even stroke.

Most of the time, you will receive corticosteroids such as prednisone by mouth. These medicines are often started even before a biopsy is done. You may also be told to take aspirin.

Most people begin to feel better within a few days after starting treatment. However, you will need to take medicine for 1 to 2 years. The dose of corticosteroids will be cut back very slowly.

Long-term treatment with corticosteroids can make bones thinner and increase your chance of a fracture. You will need to take the following steps to protect your bone strength.

  • Avoid smoking and excess alcohol intake
  • Take extra calcium and vitamin D (based on your health care provider's advice)
  • Start walking or other forms of weight-bearing exercises
  • Have your bones checked with a bone mineral density (BMD) test or DEXA scan
  • Take a bisphosphonate medicine such as alendronate (Fosamax) as prescribed by your provider.

You may also need to take other medications that suppress the immune system.

 

Outlook (Prognosis)

 

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

Damage to other blood vessels in the body such as aneurysms (ballooning of the blood vessels) may occur. This damage can lead to a stroke in the future.

 

When to Contact a Medical Professional

 

Call your health care provider if you have:

  • Throbbing headache that does not go away
  • Loss of vision
  • Other symptoms of temporal arteritis

 

Prevention

 

There is no known prevention.

 

 

Open References

References

Hellmann DB. Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In: Firestein GS, Budd RC, Gabriel SE, et al, eds. Kelley's Textbook of Rheumatology . 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 88.

 
  • Carotid artery anatomy

    Carotid artery anatomy - illustration

    There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

    Carotid artery anatomy

    illustration

    • Carotid artery anatomy

      Carotid artery anatomy - illustration

      There are four carotid arteries, two on each side of the neck: right and left internal carotid arteries, and right and left external carotid arteries. The carotid arteries deliver oxygen-rich blood from the heart to the head and brain.

      Carotid artery anatomy

      illustration

    A Closer Look

     

      Self Care

       

        Tests for Temporal arteritis

         
           

          Review Date: 1/20/2015

          Reviewed By: Gordon A. Starkebaum, MD, professor of medicine, division of rheumatology, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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