Symptoms of Temporal Arteritis (Giant Cell Arteritis)
Temporal arteritis (giant cell arteritis) presents with a characteristic constellation of cranial, systemic, and vascular symptoms, with new-onset headache being the most common presenting feature, occurring in individuals over 50 years of age. 1
Cranial Manifestations
The cranial symptoms are the hallmark features that should prompt immediate clinical suspicion:
- Headache: New-onset headache is the most frequent presenting symptom and should raise suspicion in any patient over 50 2
- Jaw claudication: Pain with chewing that has the highest diagnostic value among cranial symptoms (positive likelihood ratio of 4.90), making it one of the strongest clinical predictors 2
- Scalp tenderness: Commonly occurs and has a positive likelihood ratio of 3.14 2
- Temporal artery abnormalities: Including thickening, tenderness, and loss of pulse, with positive likelihood ratios of 4.70,3.14, and 3.25 respectively 2
Visual Symptoms
Vision loss represents the most feared complication and occurs in 14-18% of patients, making recognition of early symptoms critical to prevent irreversible blindness. 2, 3
- Visual impairment can range from transient vision changes to complete blindness 4, 5
- Rarely, patients may present with uveitis, which can delay diagnosis 4
- Third nerve palsy (pupil-sparing) has been reported as an initial presentation 5
Systemic Manifestations
Constitutional symptoms are common and include:
- Polymyalgia rheumatica symptoms: Shoulder and hip girdle pain and stiffness 2
- Constitutional symptoms: Fever, fatigue, weight loss, and malaise 1
Vascular Manifestations
Large vessel involvement produces distinctive symptoms:
- Limb claudication: Has the highest positive likelihood ratio of 6.01 among all clinical features 2
- Absent pulses: Result from arterial stenosis in large vessel involvement 1
Less Common Ischemic Complications
Rare but important presentations include:
- Stroke 3
- Cranial nerve palsies 3
- Scalp necrosis (approximately 100 cases reported) 6
- Chronic cough (respiratory involvement in <10% of cases) 3
Laboratory Findings
While not symptoms per se, these findings support the clinical diagnosis:
- Elevated ESR >40 mm/h: Present in >95% of cases, with ESR >100 mm/h having a positive likelihood ratio of 3.11 2, 3
- Elevated CRP ≥2.5 mg/dL: Elevated in most cases 2
- Platelet count >400 × 10³/μL: Has a positive likelihood ratio of 3.75 2, 3
Critical Clinical Caveat
No single symptom or laboratory finding is sufficient alone to confirm or exclude giant cell arteritis—the diagnosis requires recognition of the constellation of clinical features in the appropriate age group (>50 years). 2 The combination of new headache, jaw claudication, temporal artery abnormalities, and elevated inflammatory markers in an elderly patient should trigger immediate empiric treatment to prevent vision loss, even before diagnostic confirmation. 2, 7