Temporal arteritis / Horton disease / cranial arteritis / Giant cell arteritis

Overview – Temporal arteritis also called giant cell arteritis, horton disease, cranial arteritis is an inflammation of large- and medium-sized vessels.

The vascular involvement can be widespread, causing stenosis and aneurysm (enlargement that weakens the blood vessel) of affected vessels.

The exact cause of giant cell arteritis is not known, but a combination of genetic predisposition and environmental factors might increase the susceptibility to the condition. The predisposing risk factors are older adults, females, and individuals of Northern European ancestry.

Most often people with temporal arteritis also have polymyalgia rheumatica. Polymyalgia rheumatica is an inflammatory condition that causes pain and muscle stiffness around the shoulders and hips.

 

Symptoms –

  • Fever, fatigue, and weight loss.
  • Headache located over the temples.
  • Tenderness of the scalp to touch.
  • Jaw pain when you open your mouth wide or when you chew.
  • Transient visual loss can be an early manifestation of temporal arteritis. Transient visual loss can be a harbinger of permanent visual loss, and thus mandates urgent attention.
  • Permanent loss of vision.

 

Complications –

  • Permanent loss of vision because of diminished blood flow to the eyes.
  • Aortic aneurysm might burst, causing life-threatening internal bleeding.
  • Stroke is an uncommon complication.
  • Upper respiratory involvement is also an uncommon complication.

 

Diagnosis –

  • Blood tests in a patient with symptoms of temporal arteritis aid in the evaluation of giant cell arteritis. Erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are checked. Both these values are high when inflammation is present.
  • Temporal artery biopsy is done in all patients suspected of giant cell arteritis and is the best way to confirm the diagnosis.
  • Imaging tests that might be used to diagnose and monitor the treatment are ultrasound with doppler of the head, neck, and upper extremities; magnetic resonance angiography (MRA); and positron emission tomography (PET).

 

Medical management –

  • Treatment of giant cell arteritis requires daily glucocorticoid (prednisone) administration.
  • Other options in situations where glucocorticoid-related toxicities have ensued or are anticipated are tocilizumab, methotrexate.

 

Lifestyle management –

  • Follow the diet and exercise program as recommended by your doctor. Include fresh fruits, vegetables, whole grains in your diet.
  • Talk to your doctor about calcium and vitamin D supplementation. As long term use of glucocorticoids may lead to bone thinning and osteoporosis.
  • Your doctor may prescribe aspirin, as low dose aspirin may reduce the risk of blindness and stroke.
  • Keep all your appointments with your doctor. Your doctor will check you regularly for side effects of treatment and complications of the disease.

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