Temporal arteritis, also known as Giant Cell Arteritis (GCA), is a form of vasculitis—inflammation affecting the medium-to-large arteries of the head and neck. The condition causes artery walls to swell and narrow, restricting blood flow. Because GCA can rapidly lead to severe complications, including permanent vision loss, immediate medical attention is required.
Recognizing Symptoms and Need for Immediate Care
The symptoms of temporal arteritis can vary, but the presentation often includes a new, severe, and persistent headache, typically felt in the temporal region. Patients frequently report tenderness or pain in the scalp, particularly when touching the temples. Another common sign is jaw claudication, which is pain and cramping in the jaw muscles that occurs while chewing or talking and eases with rest.
The most concerning symptoms affect vision, necessitating an immediate physician consultation or emergency department visit. These include temporary or permanent loss of vision, often described as a shade coming down over the eye. Double vision or transient episodes of vision loss (amaurosis fugax) may serve as a warning sign. Systemic symptoms like fever, fatigue, weight loss, and muscle aches (polymyalgia rheumatica) can also be present.
The first point of contact for these symptoms is often a Primary Care Provider (PCP) or an Emergency Department physician. These initial providers are responsible for recognizing the seriousness of the potential diagnosis and initiating immediate, life-saving treatment. Prompt action is paramount because irreversible vision loss can occur within hours if treatment is delayed.
Key Specialists Involved in Diagnosis and Management
The primary specialist responsible for the long-term management and coordination of care for temporal arteritis is the Rheumatologist. Rheumatologists specialize in systemic inflammatory and autoimmune diseases, making them the most appropriate physicians for handling GCA’s complexity. They manage the long-term treatment plan, including the dosing and tapering of immunosuppressive medications.
The role of the Ophthalmologist is equally important, particularly when a patient presents with visual symptoms. These eye specialists must perform a rapid assessment to evaluate the extent of potential damage to the optic nerve and prevent further vision loss. If vision is threatened, a same-day appointment with an ophthalmologist is standard procedure.
Other physicians are involved in supportive roles. A vascular surgeon may be consulted if a temporal artery biopsy is required for diagnosis. The PCP or an internist monitors general health issues and manages the common side effects of long-term medications. Successful management relies on this coordinated, multidisciplinary approach.
Confirming the Diagnosis
The diagnostic process begins with blood tests to look for markers of inflammation. Specifically, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are typically elevated in over 95% of patients with active disease. The use of both tests provides high sensitivity for diagnosis.
The definitive procedure for confirming the diagnosis remains the Temporal Artery Biopsy (TAB). This is a minor surgical procedure where a small segment of the temporal artery is removed, usually by a surgeon, and examined under a microscope. The biopsy confirms the presence of vasculitis and the characteristic finding of multinucleated giant cells within the artery wall.
Since prompt treatment cannot wait for the biopsy results, the procedure is typically performed within one to two weeks after starting medication. Imaging techniques, such as a Doppler ultrasound of the temporal arteries, are increasingly used as a supporting diagnostic tool. This non-invasive ultrasound can reveal a characteristic “halo sign,” which represents the vessel wall edema and strongly suggests the diagnosis.
Treatment and Long-Term Monitoring
Treatment for temporal arteritis must begin immediately upon clinical suspicion, even before a definitive diagnosis is confirmed by biopsy, to prevent irreversible vision loss. The universally accepted initial treatment is high-dose corticosteroids, such as oral prednisone, typically started at a dosage of 40 to 60 mg per day for patients without visual symptoms. If vision loss or stroke is present, a higher dose of intravenous (IV) methylprednisolone is often administered for several days.
Once the disease is controlled (usually after about one month), the rheumatologist begins a slow process of corticosteroid tapering. This reduction is necessary to prevent relapse, which occurs in a significant number of patients, and the entire process may take several months to two years or more. Patients who relapse or are at high risk of steroid-related complications may be prescribed steroid-sparing agents like tocilizumab or methotrexate.
Long-term monitoring is required to manage potential complications related to both the disease and the medication. The disease itself increases the risk of serious issues like an aortic aneurysm, which necessitates regular follow-up. The prolonged use of high-dose corticosteroids requires monitoring for adverse effects such as osteoporosis, diabetes, and high blood pressure, often involving prophylactic treatments like calcium and vitamin D supplements.