Can mild pain on the temporal artery indicate giant cell arteritis?

From the Guidelines

Mild pain over the temporal artery can be a symptom of giant cell arteritis (GCA), and immediate medical attention is crucial to prevent potential complications such as permanent vision loss. This inflammatory condition affects medium and large blood vessels, particularly the temporal arteries that supply blood to the head and brain. Patients with GCA often experience tenderness, pain, or sensitivity when touching the temporal artery, which may feel nodular or have reduced pulsation, as noted in the 2020 EULAR recommendations for the management of large vessel vasculitis 1. Other common symptoms include:

• New-onset headache
• Jaw claudication (pain when chewing)
• Scalp tenderness
• Visual disturbances
• Fatigue
• Fever Diagnosis typically involves blood tests for inflammatory markers (ESR and CRP), and confirmation through a temporal artery biopsy or imaging studies such as ultrasound or MRI, as recommended in the 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of giant cell arteritis and Takayasu arteritis 1. Treatment usually begins with high-dose corticosteroids (typically prednisone 40-60mg daily) even before biopsy results, to prevent vision loss, with the goal of tapering the dose to a target of 15-20 mg/day within 2-3 months and to ≤5 mg/day after 1 year, as suggested by the EULAR recommendations 1. The inflammation in GCA occurs when the immune system attacks the blood vessel walls, causing narrowing and potential blockage of blood flow, and this condition most commonly affects people over 50 years of age, with increasing incidence in older populations, and is more common in women than men.

From the Research

Symptoms of Giant Cell Arteritis

• Mild pain on the temporal artery can be an indication of giant cell arteritis (GCA) 2
• Other symptoms of GCA include headaches, fatigue, and visual complications, which can lead to permanent visual loss if left untreated 3, 2, 4

Diagnosis of Giant Cell Arteritis

• C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be used to diagnose GCA, with a specificity of 97% 2
• Temporal artery biopsy can also confirm the diagnosis of GCA 2
• Early recognition and treatment of GCA are essential to avoid irreversible complications 3, 2, 4

Treatment of Giant Cell Arteritis

• Systemic steroids, such as prednisone, are the standard therapy for GCA 3, 5, 2
• Methotrexate can be used as an adjunctive treatment to reduce the risk of relapses and glucocorticoid exposure 3, 5, 6
• Other biologic agents, such as tocilizumab, may also be effective in treating GCA 3, 5