TEMPORAL ARTERITIS

Temporal arteritis is an inflammatory disease that involves arteries branching from the large carotid artery. Most of the structures of the head, neck, face, skull, and brain receive their blood supply from the carotid arteries. The internal carotid artery travels into the brain, branching into the main cerebral arteries as well as a small artery called the ophthalmic artery. The ophthalmic artery supplies blood to the visual cells of the eyes. The external carotid artery starts near the thyroid gland located in the neck and ends just behind the jawbone, adjacent to the ear. Here the external carotid artery branches into the temporal artery that travels in front of the ear up toward the forehead and temporal region of the skull.

Temporal arteritis is also known as giant cell arteritis or cranial arteritis because it can involve any artery in the cranium, although it commonly affects the temporal artery and the ophthalmic artery, leading to the symptoms mentioned below.

Temporal arteritis is more common in women than in men and occurs in about 20 people per 100,000 population in the United States. A unique feature of the disease is that it is exclusively found in patients older than 50 years. Temporal arteritis is not contagious or inherited. The cause of this inflammatory disease is not known, but temporal arteritis is commonly associated with another disease called polymyalgia rheumatica.

Temporal arteritis is suspected by the clinical history along with a blood test called the sedimentation rate. To detect temporal arteritis your physician will recommend a biopsy of the temporal artery (removing a small piece of the temporal artery with minor surgery and looking at it under a microscope).

Temporal arteritis is curable.

The typical presentation is found in an elderly patient with complaints of headache, scalp tenderness, visual disturbances, and pain with chewing food (jaw claudication). The patient may also complain of fever, weakness, fatigue, and weight loss. Associated symptoms of aching and stiffness of the muscles of the neck, back, shoulders, and hips suggest polymyalgia rheumatica. Perhaps the most worrisome complication of temporal arteritis is the loss of vision, which is considered a medical emergency requiring immediate treatment.

Once the diagnosis of temporal arteritis is established your doctor will recommend prednisone therapy. Prednisone is usually started at 40 to 60 mg per day. The same dose is continued for the first month. If symptoms and the sedimentation blood test have improved, your doctor will begin to taper the dose of prednisone gradually. The specific prednisone tapering recommendation should be discussed between you and your physician, but it is important to remember that the duration of treatment will be from 1 to 2 years.

In patients with visual loss or visual impairment from the disease, your physician may recommend prednisone be given intravenously. This decision is made between you and your physician.

• Understand the potential side effects from prednisone. Cataracts, peptic ulcer disease, osteoporosis, diabetes, and hypertension are all potential side effects from long-term use of prednisone.
• Seek the opinion of an ophthalmologist (physician specializing in the diseases of the eye).
• Realize that temporal artery biopsies may not always provide the answer. The disease can skip areas of the artery, and the biopsy site removed can represent a normal artery or normal portion of the artery although you may have the disease.

• Don't miss follow-up visits. It is important for your physician to monitor your symptoms and blood test (sedimentation rate). With treatment, your symptoms should improve and the sedimentation rate should return back to normal range. This serves as a monitor to taper down on the prednisone therapy and also serves to inform the physician if there is a relapse as the treatment is tapered.
• Don't forget that prednisone therapy for temporal arteritis is recommended anywhere from 1 to 2 years. The duration of therapy is long to prevent the disease from coming back.
• Don't ignore any visual disturbances. Blindness can occur in patients with temporal arteritis.

• If you have any visual loss or change in vision.
• If you have new onset headaches with fever.
• If you have pain with chewing food or any of the above-mentioned symptoms.

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