Temporal arteritis, also known as Giant Cell Arteritis (GCA), is a serious inflammatory condition affecting the medium-to-large arteries of the body, most commonly those in the head and neck. This inflammation causes the blood vessels to swell and narrow, which can severely restrict blood flow to the eyes and brain. Because of the immediate and high risk of permanent vision loss, which occurs in up to 20% of untreated cases, temporal arteritis is considered a medical emergency requiring swift intervention.
Initial Medical Response and Urgency
A patient with suspected temporal arteritis may first contact a Primary Care Provider (PCP), an Emergency Room (ER) physician, or an Ophthalmologist, particularly if visual disturbances are the presenting symptom. Symptoms like a new, persistent headache, scalp tenderness, or jaw pain while chewing should prompt immediate medical evaluation.
The most time-sensitive action is the immediate initiation of high-dose corticosteroid treatment, typically prednisone at 40 to 60 milligrams per day, based on clinical suspicion alone. This intervention must not be delayed while waiting for diagnostic confirmation, such as a temporal artery biopsy, because delay increases the risk of irreversible blindness. For patients presenting with acute visual changes or a high suspicion of impending vision loss, intravenous methylprednisolone, often 1000 mg daily for three days, is the preferred initial treatment to suppress the inflammation rapidly.
The initial diagnosing physician is responsible for this rapid assessment and for prescribing the first dose of glucocorticoids. They must also immediately coordinate a referral to a specialist, ensuring a smooth transition of care. While the PCP or ER doctor starts the treatment, they are not typically the ones who manage the long-term, complex course of the disease.
The Central Role of the Rheumatologist
The Rheumatologist, a specialist in inflammatory and autoimmune conditions, is the primary physician responsible for the comprehensive and long-term management of Giant Cell Arteritis. They take over the patient’s care after the initial emergency phase and are responsible for confirming the diagnosis.
Diagnosis is confirmed either through a temporal artery biopsy, which remains the gold standard, or specialized imaging techniques like temporal artery ultrasound, which can identify the characteristic “halo sign” of vessel wall thickening. The biopsy is typically performed within one to two weeks of starting steroids, as the medication does not immediately eliminate the signs of inflammation in the tissue.
The rheumatologist then establishes the long-term treatment plan, which is centered on carefully tapering the high-dose corticosteroids. This tapering process is complex and slow, often spanning 12 to 24 months, with the dose gradually reduced based on the patient’s symptoms and inflammatory markers like C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). They are also the specialists who integrate steroid-sparing agents, such as the biologic drug tocilizumab, to reduce the cumulative exposure to corticosteroids and prevent disease relapse.
Monitoring and Specialized Consultation
The Ophthalmologist plays a crucial and ongoing role, especially if the patient presented with or is at risk for visual symptoms. They monitor the patient’s visual health to detect and manage any ocular complications, such as ischemic optic neuropathy, which can lead to permanent vision loss. A Neurologist may also be involved if the patient experiences symptoms suggesting involvement of the cerebral arteries, such as stroke or transient ischemic attack (TIA).
The Primary Care Provider remains an important partner in care, focusing on managing the common and significant side effects of long-term high-dose corticosteroid use. These side effects include bone loss (osteoporosis), high blood pressure (hypertension), and the development or worsening of diabetes. The PCP will coordinate preventative measures like prescribing calcium and vitamin D supplements or bisphosphonates to protect bone health.