What are the symptoms of temporal arteritis in individuals over 50 years old?

Symptoms of Temporal Arteritis

Temporal arteritis presents with new-onset persistent headache (often temporal), scalp tenderness, jaw claudication, and constitutional symptoms in individuals over 50 years old, requiring immediate recognition to prevent permanent vision loss. 1, 2

Cardinal Cranial Symptoms

The most characteristic symptoms involve the head and face:

• Headache is the most common symptom, occurring in two-thirds of patients and up to 90% of those with biopsy-proven disease, typically described as new-onset, persistent, and localized to the temporal area 1, 2
• Scalp tenderness is highly characteristic, often noticed when combing hair or resting the head on a pillow 1, 2
• Jaw claudication (pain with chewing or speaking) is highly specific with a positive likelihood ratio of 4.90, making it one of the most diagnostically valuable symptoms 2, 3
• Tongue claudication may also occur and shares similar diagnostic specificity 2

Visual Symptoms (Ophthalmologic Emergency)

Visual manifestations represent the most serious complications:

• Transient visual symptoms including amaurosis fugax (temporary vision loss), diplopia, or blurred vision occur in approximately 20% of patients 1, 4
• Permanent vision loss occurs in 10-18% of patients if untreated, typically from anterior ischemic optic neuropathy or central retinal artery occlusion 1, 5, 6
• Visual symptoms may be unilateral initially but can progress to bilateral blindness without immediate treatment 6, 7

Physical Examination Findings

Key findings on examination include:

• Temporal artery abnormalities: tenderness, thickening, nodularity, or reduced/absent pulsation with a positive likelihood ratio of 3.14-4.70 2
• These findings may be subtle or absent in some patients, particularly those with predominantly large vessel involvement 1

Constitutional Symptoms

Systemic manifestations occur in approximately half of patients:

• Fever (typically low-grade), malaise, night sweats, and unintentional weight loss 1
• Polymyalgia rheumatica symptoms including shoulder and hip girdle pain and stiffness 4
• General feeling of being unwell or depression 6

Less Common Manifestations

Additional symptoms that may occur:

• Respiratory symptoms: chronic cough (harsh and nonproductive) occurs in less than 10% of cases, sometimes with sore throat and hoarseness 1, 5
• Neurologic complications: stroke, cranial nerve palsies, or scalp necrosis from severe ischemia 5
• Large vessel involvement: limb claudication or absent pulses from arterial stenosis or aneurysms 1

Laboratory Abnormalities

While not symptoms per se, these findings strongly support the diagnosis:

• Elevated inflammatory markers in over 95% of cases: ESR typically >40 mm/h (ESR >100 mm/h has positive LR of 3.11) and elevated CRP 2, 5, 8
• Thrombocytosis: platelet count >400 × 10³/μL has a positive likelihood ratio of 3.75 2
• Anemia may be present 9

Critical Clinical Pitfall

Any patient over 50 years old presenting with new-onset headache, particularly when accompanied by jaw claudication, scalp tenderness, or visual symptoms, should be considered to have temporal arteritis until proven otherwise and requires same-day evaluation with inflammatory markers and urgent referral within 24 hours. 1, 2, 7 The absence of elevated CRP (≥2.5 mg/dL) has a negative likelihood ratio of 0.38, making temporal arteritis less likely but not excluded 2. Treatment with high-dose glucocorticoids (40-60 mg prednisone daily) should be initiated immediately upon clinical suspicion, even before biopsy confirmation, as this is the only intervention that prevents irreversible blindness 1, 2, 8.