Temporal arteritis
Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition affecting the medium- and large-sized arteries, particularly the temporal artery located in front of the ear. This condition predominantly occurs in adults over the age of fifty, with a higher prevalence in women and individuals of Scandinavian descent. The exact cause of temporal arteritis is unknown, but it is believed to be linked to autoimmune reactions, potentially triggered by viral infections and associated with the aging process. Common symptoms include severe headaches, tender scalp, jaw pain, and vision changes, with many patients also experiencing polymyalgia rheumatica. Prompt diagnosis, often through a temporal artery biopsy, is crucial as untreated temporal arteritis can lead to serious complications, including permanent vision loss. Treatment typically involves high doses of corticosteroids to reduce inflammation, with the goal of preventing flare-ups and managing symptoms. Long-term use of steroids poses risks, prompting recommendations for lifestyle adjustments to maintain bone health. Overall, while many respond well to treatment, recurrence of symptoms can occur, necessitating ongoing management.
Temporal arteritis
Disease/Disorder
Also known as: Giant cell arteritis
Anatomy or system affected: Blood vessels, circulatory system, immune system
Definition:Inflammation of the medium and large blood vessels that bring blood to the temporal area of the head; may also occur in vessels in other parts of the body.
Causes and Symptoms
Arteries are blood vessels that carry oxygenated blood away from the heart to supply oxygen and nutrients to cells. Inflammation of an artery is called arteritis; blockage of an artery from arteritis or other causes can cause damage to the body and may even lead to death. The temporal artery is located in front of the ear and is a major supplier of blood to the head.
In some adults, the medium- and large-sized arteries in the head can become swollen and can decrease or block the flow of blood. The cause of the swelling is unknown, but it is thought to be an autoimmune disorder, where the body mistakenly attacks its own healthy cells, and may be triggered by a virus. This reaction is thought to be connected to the process of aging. Temporal arteritis is almost always found in adults who are older than fifty, with an average age of onset of seventy-two, and it is two to three times more common in women than in men. Whites, particularly those of Scandinavian heritage, are most more frequently affected while the disease is rare among those of African descent, but it can occur among people of any race. A person is more likely to get temporal arteritis if someone else in the family has had the condition, suggesting a potential genetic link.
The first symptom of temporal arteritis is usually a severe headache in the temple, which does not get better after taking pain medication. The patient may also experience a sensitive or tender scalp. A person with temporal arteritis typically has pain in their jaw or other parts of their face and has some change in their vision. Almost half of the people who are diagnosed with temporal arteritis also have polymyalgia rheumatica (PMR), a condition where they are stiff in the morning and have aches in the neck, shoulder, chest, or hip.
People with this condition might also have a fever, feel tired or weak, lose their appetite, or lose weight. While these symptoms are considered “classic,” 40 percent of people will experience different symptoms.
Treatment and Therapy
Temporal arteritis is diagnosed by a temporal artery biopsy, but most medical providers will begin treatment for this disorder if the person has symptoms because it is so important to start treatment quickly to prevent blindness. In addition to the biopsy, blood work may be done to look for an increased number of white blood cells (WBC) and an elevated erythrocyte sedimentation rate (ESR), which are both indicators of inflammation in the body.
The treatment is high doses of corticosteroids, generally prednisone, that are taken for a long period of time, sometimes as long as two years. The initial treatment is so strong that it may need to be given intravenously (IV) but the dose will begin to be tapered, or decreased, once the person's symptoms go away and their white blood cell level decreases. Typical doses are administered orally. Some patients may also be prescribed a dose of aspirin for anti-platelet therapy or a regimen of other medications aimed at suppressing the immune system.
Though treatment usually clears up symptoms quickly, taking steroids for long periods of time puts a person at a higher risk for developing osteoporosis and other negative side effects. For this reason patients are typically recommended to take measures to boost their bone strength and overall health, such as taking calcium or vitamin D supplements, exercising, and refraining from smoking and drinking alcohol.
Prognosis
Permanent blindness can happen if this disorder is not treated quickly. Long-term use of steroid medications help to make the bothersome symptoms go away, but half of the people with this disorder will have a flare-up within a year, even while taking steroids. Many people have to take steroids at a lower dose for several years to keep the symptoms from happening again.
Bibliography
Cooper, Matthew M. "Temporal Arteritis." MedlinePlus. Natl. Lib. of Medicine, Natl. Institutes of Health, 6 Feb. 2013. Web. 18 Mar. 2015.
Firestein, Gary S., et al. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia: Elsevier, 2013. Print.
"Giant Cell Arteritis." Johns Hopkins Vasculitis Center. Johns Hopkins Vasculitis Center, 2015. Web. 17 Mar. 2015.
"Giant Cell Arteritis." Mayo Clinic. Mayo Foundation for Medical Education and Research, 5 Oct. 2012. Web. 18 Mar. 2015.
Goldman, Lee, and Andrew I. Schafer. Goldman's Cecil Medicine. 24th ed. Philadelphia: Elsevier, 2012. Print.
Hazzard, William R., et al. Hazzard's Principles of Geriatric Medicine and Gerontology. 6th ed. New York: McGraw-Hill, 2009. Print.