Temporal arteritis

Temporal arteritis, also called giant cell arteritis (GCA) is an inflammatorydisease of blood vessels(most commonly large and medium arteriesof the head). It is therefore a form of vasculitis. The name comes from the most frequently involved vessel (temporal arterywhich branches from the external carotid arteryof the neck). The alternative name (giant cell arteritis) reflects the type of inflammatory cell that is involved (as seen on biopsy).

The disorder may coexist (in one quarter of cases) with polymyalgia rheumatica(PMR), which is characterized by sudden onset of pain and stiffness in muscles (pelvis, shoulder) of the body and seen in the elderly. Other diseases related with temporal arteritis are systemic lupus erythematosus, rheumatoid arthritisand severe infections.

Symptoms

It is more common in females and after 50 years of age. Below this age it is extremely rare.

Patients present with:

• fever
• headache
• tenderness and sensitivity on the scalp
• jawclaudication
• reduced visual acuity(blurred vision)
• acute visual loss(sudden blindness)

The inflammation may affect blood supply to the eyeand blurred vision or sudden blindnessmay occur. In 76% of cases involving the eye the optic nerveis involved causing anterior ischemic optic neuropathy. Loss of vision in both eyes may occur very abruptly and this disease is therefore a medical emergency.

Diagnosis

Palpation of the head reveals sensitive and thick arteries with or without pulsation. Sedimentation rateis very high in most of the patients, but may be normal in approximately 20% of cases. The inflammation of the vessel must be demonstrated by removing a small part of the vessel (biopsy) and analysing it for giant cells infiltrating the tissue. Since the vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a negative result does not definitely rule out the diagnosis.

Treatment

Corticosteroidsmust be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy).

References

• U of Iowa Prof. Sohan Singh Hayreh's Giant Cell Arteritis article
• Polymyalgia rheumatica article from National Institute of Arthritis and Musculoskeletal and Skin Diseases
• eMedicine Neurology article on Temporal/Giant Cell Arteritisde:Arteriitis cranialis

This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Temporal+arteritis Wikipedia article Temporal arteritis.