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Temperal Arteritis

Temperal arteritis is an inflammation of medium- and large-sized arteries. The disorder most frequently involves one or more branches of the carotid artery, particularly the temporal artery. The disorder is a

Incidence And Prevalence

Temperal arteritis has a high incidence in Scandanavia and in regions of the United States with large Scandanavian populations, compared to a lower incidence in southern Europe. The annual incidence rates in individuals 50 years of age and older range from 0.49 to 23.3 per 100,000 population. It occurs almost exclusively in individuals older than, aritis, polymyalgea, rumatica, polymyalgea, rumatica, temperal arteritis, temporel arteritis

Pathophysiology And Pathogenesis

Although the temperal artery is most frequently involved in this disease, patients often have a systemic vasculitis of multiple medium- and large-sized arteries, which may go undetected. Histopathologically, the disease is a panarteritis with inflammatory mononuclear cell infiltrates within the vessel wall with frequent giant cell formation. There is proliferation of the intima and fragmentation of the internal elastic lamina. Pathophysiologic findings in organs result from the ischemia related to the involved vessels. Distinct cytokine patterns as well as T lymphocytes expressing specific antigen receptors have been described suggesting the involvement of immunopathogenic mechanisms in giant cell arteritis. IL-6 and IL-1-beta expression has been detected in a majority of circulating monocytes of patients with giant cell arteritis and polymyalgia rheumatica. T cells recruited to vasculitic lesions in patients with giant cell arteritis produce aritis predominantly IL-2 and IFN-gamma, and the latter has been suggested to be involved in the progression to overt arteritis. Sequence analysis of the T cell receptor of tissue-infiltrating T cells in lesions of giant cell arteritis indicates restricted clonal expansion, suggesting that an antigen residing in the arterial wall is recognized by a small fraction of T cells.

Clinical And Laboratory Manifestations of Temperal Arteritis

The disease is characterized clinically by the classic complex of fever, anemia, high ESR, and headaches in an elderly patient. Other manifestations include malaise, fatigue,

In patients with involvement of the temporal artery, headache is the predominant symptom and may be associated with a tender, thickened, or nodular artery, which may pulsate early in the disease but become occluded later. Scalp pain and claudication of the jaw and tongue may occur. A well-recognized and dreaded complication of giant cell

Characteristic laboratory findings in addition to the elevated ESR include a normochromic or slightly hypochromic anemia. Liver function abnormalities are common, particularly increased alkaline phosphatase levels. Increased levels of IgG and complement have been reported. Levels of enzymes indicative of muscle damage such as serum creatine kinase are not elevated.

Diagnosis of Temporal Arteritis

The diagnosis of temporal arteritis can be made clinically by the demonstration of the classic picture of fever, anemia, and high ESR with or without symptoms of polymyalgia rheumatica in an elderly patient. The diagnosis is confirmed by biopsy of the temporal artery. Since involvement of the vessel may be segmental, the diagnosis may be missed on

Treatment of temporal arteritis

Giant cell arteritis and its associated symptoms are exquisitely sensitive to glucocorticoid therapy, polymyalgea, rumatica. Treatment should begin with prednisone, 40 to 60 mg per day for