Temporal Arteritis - Causes, Symptoms, and Treatment

Introduction

Temporal arteritis, also known as giant cell arteritis (GCA), is a vascular condition affecting older individuals. The condition is characterized by inflammation of medium to large-sized arteries (blood vessels), particularly the temporal arteries, and can lead to significant complications, including vision loss and stroke. This article briefly explains temporal arteritis, including its causes, symptoms, diagnosis, and treatment.

What Is Temporal Arteritis?

Temporal arteritis (TA) or giant cell arteritis (GCA) is a type of vasculitis (inflammation of blood vessels) that causes the inflammation of medium and large-sized arteries (blood vessels). It most commonly involves the temporal artery, which supplies blood to the scalp and is located on both sides of the head. The exact cause of the condition is unknown. The condition occurs most frequently in adults. If left untreated, TA leads to ischemic optic neuropathy, which can cause vision loss on the affected side or the opposite side.

What Causes the Temporal Arteritis?

The exact cause of temporal arteritis is not known. However, it is thought to occur from an abnormal immune response that mistakenly attacks the vessels and leads to inflammation, swelling, and narrowing of the arteries, particularly the temporal arteries.

Other risk factors include:

• Advancing age.

• Smoking.

• Genetics.

• Severe Infections.

What Are the Symptoms of Temporal Arteritis?

1. General Symptoms: Almost all individuals with TA may have all general symptoms or one of the symptoms such as:

• Weight loss.

• Fever.

• Fatigue.

• Anorexia.

• Malaise.

2. Headache: Headaches can be severe, accompanied by scalp tenderness. Such headaches do not respond to typical over-the-counter analgesics.

3. Jaw Pain and Discomfort: Due to decreased blood supply to jaw muscles, there is pain and discomfort in the jaw while chewing food or talking.

4. Temporal Artery Abnormality: Up to 50 percent of patients with TA have temporal artery abnormality Enlargement, nodular swelling, tenderness, and loss of pulse of the temporal artery, either on one side or both sides.

5. Visual Symptoms: Problems with eyesight may occur which include:

• Blurred vision.

• Double vision.

• Blindness in one or both eyes.

6. Neurological Symptoms: About 30 percent of individuals may experience neurological symptoms which include:

• Transient ischemia or strokes.

• Loss of shoulder abduction.

7. Respiratory Symptoms: Some patients with TA may experience cough (with or without sputum), sore throat, or hoarseness of voice.

8. Polymyalgia Rheumatica (PMR): Temporal arteritis is often associated with PMR, a condition characterized by muscle pain and stiffness, especially in the shoulders, hips, and neck.

How Is Temporal Arteritis Diagnosed?

Diagnosing temporal arteritis involves a combination of physical examination, medical history, blood tests, biopsy, and imaging tests.

1. Medical History and Physical Examination: The doctor will start by taking a thorough medical history, including asking about symptoms such as headaches, jaw pain, vision changes, and other relevant complaints.

2. Blood Tests: Blood tests may include:

• Complete blood count.

• Erythrocyte sedimentation rate (ESR).

• C-reactive protein (CRP).

3. Biopsy: When a doctor suspects temporal arteritis, a biopsy is recommended in which a tiny section of the artery is cut out and inspected for signs of vascular inflammation.

4. Imaging Test: Several imaging modalities have been used to diagnose TA, including

• Conventional angiography.

• Computed tomography angiography (CTA).

• Magnetic resonance angiography (MRA).

• Color Doppler ultrasonography.

• Positron emission tomography (PET) scan.

What Are the Complications of Temporal Arteritis?

Irreversible vision loss is the most feared complication of giant cell arteritis. Other complications include:

• Stroke.

• Aortic aneurysms (bulges in the wall of the main artery of the heart called the aorta).

• Scalp necrosis can be seen in rare and severe cases.

• Tongue necrosis due to poor blood flow to the jaw muscles can lead to tissue damage.

• Corticosteroids-related complications such as osteoporosis and gastrointestinal disturbances.

What Is the Treatment of Temporal Arteritis?

Although there is no known treatment for temporal arteritis, it can be managed with medicine as soon as possible to stop further damage from inadequate blood supply.

1. Corticosteroids:

Corticosteroids continue to be the primary therapeutic option for preventing irreversible loss of vision. In suspected situations, corticosteroids should be started as soon as possible. Patients using corticosteroids need to be closely monitored because prolonged use of these medications might have substantial side effects, such as bone thinning and increased risk of infections.

2. Other Medications:

• Low-Dose Aspirin – To reduce the possibility of a heart attack or stroke, which may occur if the arteries of the heart become narrowed

• Proton Pump Inhibitors (PPIs) – To reduce the risk of getting stomach problems like stomach ulcers, which is a side effect of taking corticosteroids.

• Bisphosphonate Therapy – To reduce the risk of bone fractures when taking corticosteroids.

• Immunosuppressants – Used in combination with corticosteroids to allow steroid medicine to be reduced and contribute to preventing temporal arteritis from returning.

What Is the Outlook of the Temporal Arteritis?

When diagnosed early and treated appropriately, the prognosis for TA is usually favorable, unless the person has had a loss of vision. If the vision loss occurs, it cannot be reversed. TA can cause damage to other blood vessels in the body, such as aneurysms (ballooning of the blood vessels). This damage can eventually result in a stroke. Most of the complications of temporal arteritis arise from the long-term use of corticosteroids that lead to bone thinning and increased risk of infections.

What Is the Differential Diagnosis of Temporal Arteritis?

Temporal arteritis may share symptoms similar to other conditions, making it difficult to differentiate such conditions, including:

• Atherosclerosis and thromboembolism.

• Malignancies such as lymphoma and myeloma.

• Amyloidosis.

Conclusion

Temporal arteritis, also known as giant cell arteritis (GCA), is a vascular condition affecting older individuals. If left untreated, the condition can lead to irreversible vision loss, aortic aneurysms, stroke, and scalp necrosis. With early recognition of symptoms, proper diagnosis and course of treatment are crucial to decrease the risk of complications and minimize their impact on patients' lives. This allows individuals who have temporal arteritis to effectively manage their condition and maintain good quality of life.