Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition affecting blood vessels, primarily in the head. While not “cured” in the traditional sense, it is highly treatable and manageable, often leading to remission. Early diagnosis and prompt treatment are important to prevent serious complications.
Understanding Temporal Arteritis
Temporal arteritis is characterized by the inflammation of medium to large-sized arteries, particularly those that supply blood to the head, eyes, and jaw. This condition is classified as a type of vasculitis, an autoimmune condition where the body’s immune system mistakenly attacks its own healthy blood vessel tissue. Genetic predispositions and environmental triggers are thought to contribute to its development.
This condition predominantly affects individuals over the age of 50, with cases being rare in younger populations. There is a higher prevalence observed in people of Northern European descent, and women tend to have a slightly higher incidence compared to men.
Common symptoms include:
New onset headaches, often severe and localized to the temples
Scalp tenderness
Jaw pain that worsens with chewing (claudication)
Visual disturbances like blurred vision, double vision, or temporary vision loss
Systemic symptoms such as fatigue, low-grade fever, and unexplained weight loss
Identifying Temporal Arteritis
Prompt diagnosis of temporal arteritis is important to prevent complications, including permanent vision loss. A healthcare professional assesses symptoms and conducts a physical examination, checking temporal arteries for tenderness, swelling, or a reduced pulse. These findings guide initial suspicion.
Blood tests help identify inflammation. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are common markers that indicate inflammation and are often elevated in temporal arteritis, though they are not specific to this condition.
A temporal artery biopsy is the primary method for confirming diagnosis. This minor surgical procedure involves removing a small artery segment for microscopic examination, looking for characteristic inflammatory cells. “Skip lesions,” where inflammation is not continuous, mean a negative biopsy doesn’t always rule out the condition. Treatment may begin based on strong clinical suspicion before biopsy results to protect against vision loss. Non-invasive imaging like color duplex ultrasonography, MRI, or PET scans are also used, especially when biopsy results are inconclusive or not feasible.
Treatment Approaches for Temporal Arteritis
High-dose oral corticosteroids, such as prednisone, are the primary treatment approach for temporal arteritis. Treatment is often started immediately upon clinical suspicion, even before a confirmed diagnosis, because of the need to protect vision. These corticosteroids function by rapidly suppressing the immune system and reducing inflammation throughout the body.
The initial dose of corticosteroids is typically high and is gradually tapered down over many months or even several years, based on improvements in symptoms and normalization of inflammatory markers. This extended tapering process highlights that it is a long-term treatment regimen.
Long-term corticosteroid use can lead to potential side effects, including:
Osteoporosis
Weight gain
Elevated blood pressure
Increased blood sugar (which can lead to steroid-induced diabetes)
Mood changes
Increased susceptibility to infections
Strategies to mitigate these side effects often include calcium and vitamin D supplementation to protect bone density, along with regular monitoring of bone health. Lifestyle adjustments are also important in managing these potential issues. Other medications, referred to as steroid-sparing agents, may be used in conjunction with corticosteroids or for patients who experience frequent relapses or cannot tolerate high steroid doses. For instance, tocilizumab, an interleukin-6 receptor inhibitor, may be employed to reduce the overall reliance on corticosteroids.
Long-Term Management and Outlook
While temporal arteritis is not permanently eradicated, it can enter a state of remission where symptoms and inflammation are effectively controlled. Long-term management and ongoing vigilance are important for a favorable outcome. Many patients achieve remission, but relapses can occur, particularly when the steroid dose is being reduced or discontinued.
Ongoing medical monitoring by specialists, often a rheumatologist, is important to manage the condition. This includes regular follow-up appointments, blood tests to monitor inflammatory markers like ESR and CRP, and clinical evaluations to assess disease activity. Adjustments to medication are made as needed based on these assessments.
Untreated or poorly managed temporal arteritis can lead to serious complications. Vision loss is an often irreversible complication, ranging from temporary disturbances to permanent blindness in one or both eyes. There is also a risk of stroke if inflammation affects arteries supplying the brain. A long-term concern is the weakening of the aorta, the body’s largest artery, which can lead to an aortic aneurysm (a bulge) or dissection (a tear). This complication can occur even years after diagnosis, emphasizing the need for regular imaging surveillance, such as chest X-rays or CT scans, in some cases to monitor the aorta. With early diagnosis and appropriate, consistent long-term treatment, the outlook for individuals with temporal arteritis is generally favorable. Most can lead full, active lives, though ongoing medical supervision and self-management are often required to maintain remission and prevent complications.