From the Guidelines
Temporal arteritis, also known as giant cell arteritis, is an elastic vessel vasculitis involving the aorta and its secondary and tertiary branches, typically affecting patients above the age of 50 years, with a predilection for those of northern European ancestry. This condition requires a heightened suspicion by clinicians for early diagnosis due to its varied clinical presentation, which can include constitutional symptoms such as weight loss, night sweats, malaise, and fever, as well as cranial symptoms like scalp tenderness, headache, jaw claudication, and visual disturbances 1.
Key Characteristics
- The disease affects women in a 3:2 ratio to men, with an incidence peaking in the eighth decade of life 1.
- The prevalence in the United States is reported as 20 cases per 100,000 persons, with higher incidence in Scandinavian nations and lower in southern Europe, suggesting a genetic predisposition in certain populations 1.
- Clinical presentation can include:
- Constitutional symptoms (weight loss, night sweats, malaise, fever) in half of the patients.
- Cranial symptoms (scalp tenderness, headache) in two thirds of patients and up to 90% of patients with biopsy-proved disease.
- Jaw claudication in half of the patients.
- Diplopia, amaurosis fugax, or blurriness prior to blindness in 20% of patients.
Treatment Approach
Corticosteroids, specifically prednisone at a dose of 40 to 60 mg daily, although recent evidence suggests similar efficacy with 30 to 40 mg daily, represent the standard therapy for patients with GCA. Therapy is typically required for 1 to 2 years to avoid recurrence, with the dose potentially tapered beginning 2 to 3 months after initiation 1. It's crucial to monitor patients closely for symptoms, inflammatory markers, and potential steroid side effects, considering the addition of steroid-sparing agents like methotrexate or tocilizumab in some cases. Preventative measures against steroid-induced osteoporosis and gastric protection should also be considered.
From the Research
Definition and Overview of Temporal Arteritis (Giant Cell Arteritis)
- Temporal arteritis, also known as giant cell arteritis, is not directly defined in the provided studies 2, 3, 4, 5, 6.
- The studies primarily focus on rheumatoid arthritis, disease-modifying antirheumatic drugs (DMARDs), and the management of osteoarthritis and other inflammatory rheumatic diseases.
Related Conditions and Treatments
- Rheumatoid arthritis is an autoimmune, destructive, inflammatory arthritis in adults, and its treatment includes oral conventional synthetic DMARDs, injectable biologic DMARDs, and targeted synthetic DMARDs 3.
- DMARDs are used to treat various arthritic conditions, including rheumatoid arthritis, and can relieve pain and inhibit disease progression 4.
- The management of osteoarthritis involves non-pharmacological and pharmacological interventions, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) as first-line therapy 5.
- Perioperative management of DMARDs and other immunomodulators is crucial for patients with inflammatory rheumatic diseases undergoing elective surgery 6.