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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.
Temperal arteritis has a high incidence in Scandinavian and in regions of the United States with large Scandinavian 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 temperal arteritis.
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.
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 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
Giant cell arteritis and its associated symptoms are exquisitely sensitive to glucocorticoid therapy. Treatment should begin with prednisone, 40 to 60 mg per day.