What are the symptoms of Temporal Arteritis?

Symptoms of Temporal Arteritis (Giant Cell Arteritis)

Temporal arteritis presents with new-onset persistent localized headache (often temporal), jaw claudication, visual disturbances, and constitutional symptoms—recognition of these features is critical as immediate high-dose glucocorticoid therapy can prevent permanent vision loss. 1

Cardinal Symptoms

Cranial Manifestations

• New-onset persistent localized headache, most commonly in the temporal area, occurring in two-thirds of patients and up to 90% of those with biopsy-proven disease 1
• Scalp tenderness, present in approximately two-thirds of patients 1
• Jaw and/or tongue claudication, affecting half of patients and highly specific with a positive likelihood ratio of 4.90 1, 2, 3
• Acute visual symptoms including amaurosis fugax, acute visual loss, and diplopia—occurring in 20% of patients prior to blindness 1

Constitutional Symptoms

• Weight loss >2 kg, low-grade fever, fatigue, and night sweats occur in approximately half of patients 1
• Malaise and depression may accompany the temporal pain 4

Associated Conditions

• Polymyalgia rheumatica symptoms including myalgias and arthralgias 1, 5
• Limb claudication from large vessel involvement 1

Key Physical Examination Findings

Vascular Signs

• Tenderness and/or thickening of the superficial temporal arteries with or without reduced pulsation (positive likelihood ratio 3.14-4.70) 1, 2
• Bruits, particularly in the axilla, indicating large vessel involvement 1
• Reduced pulses or blood pressure asymmetry in the upper limbs 1

Ophthalmologic Findings

• Anterior ischemic optic neuropathy (the most common cause of permanent blindness) 1, 4
• Oculomotor cranial nerve palsies 1
• Central or branch retinal artery occlusion 1, 6
• Choroidal ischemia 1

Laboratory Abnormalities

• Elevated erythrocyte sedimentation rate (ESR) found in >95% of cases, with ESR >100 mm/h having a positive likelihood ratio of 3.11 2, 3
• Elevated C-reactive protein (CRP) present in >95% of cases, with absence of CRP ≥2.5 mg/dL having a negative likelihood ratio of 0.38 2
• Platelet count >400 × 10³/μL with a positive likelihood ratio of 3.75 2
• Anemia commonly present 6

Atypical Presentations

Less Common Manifestations

• Dry cough and respiratory tract symptoms occur in approximately 40% of patients with atypical presentations 3
• Fever of unknown origin 3
• Toothache and tongue infarction from lingual artery involvement 3

Critical Clinical Pitfalls

Patients with acute visual disturbance and typical symptoms with elevated inflammatory markers require immediate treatment before diagnostic confirmation, as delaying glucocorticoid therapy when visual loss is present is the strongest risk factor for permanent blindness. 1

The symptoms can be vague, non-specific, and gradual in onset, potentially mimicking angle-closure glaucoma, hypertension, migraine, trigeminal neuralgia, temporomandibular joint syndrome, carotid artery occlusive disease, or non-arteritic anterior ischemic optic neuropathy 4, 7. However, approximately 89% of patients have an ESR >50 mm/h, which helps distinguish temporal arteritis from these mimics 3.

Fast-track referral within 24 hours is recommended for all suspected cases to reduce the rate of permanent visual impairment, and diagnostic tests should be performed regardless of whether pre-emptive glucocorticoid therapy has been initiated. 1, 2