From the Guidelines
Temporal arteritis, also known as giant cell arteritis, is a medical emergency that typically presents with severe headaches, scalp tenderness, jaw claudication, and vision changes, requiring immediate treatment with high-dose corticosteroids to prevent permanent vision loss. The condition is characterized by inflammation of the blood vessels, which restricts blood flow, particularly to the eyes, and can cause sudden vision loss [ 1 ]. Patients may also experience fatigue, fever, weight loss, shoulder and hip pain, and general malaise.
Clinical Presentation
The clinical presentation of temporal arteritis is varied, requiring a heightened suspicion by clinicians for early diagnosis [ 1 ]. Half of the patients report constitutional symptoms, such as weight loss, night sweats, malaise, and fever. Cranial symptoms are common, with scalp tenderness and headache present in two thirds of patients and in up to 90% of patients with biopsy-proved disease. Jaw claudication is common and affects half of the patients, 20% report diplopia, amaurosis fugax, or blurriness prior to blindness.
Diagnosis and Treatment
Diagnosis is confirmed through blood tests showing elevated inflammatory markers (ESR, CRP) and a temporal artery biopsy [ 1 ]. If temporal arteritis is suspected, patients should seek immediate medical attention for prompt initiation of high-dose corticosteroids, typically prednisone 40-60mg daily, which should not be delayed even for diagnostic testing. Treatment typically continues for 1-2 years with gradual tapering of steroids, and regular monitoring is essential to manage potential side effects of long-term steroid use [ 1 ].
Epidemiology
The condition primarily affects adults over 50, with women being more susceptible than men [ 1 ]. The inflammation of blood vessels in temporal arteritis restricts blood flow, particularly to the eyes, which explains the risk of sudden vision loss.
Key Points
- Temporal arteritis is a medical emergency requiring immediate treatment
- High-dose corticosteroids, typically prednisone 40-60mg daily, should be initiated promptly
- Diagnosis is confirmed through blood tests and a temporal artery biopsy
- Treatment typically continues for 1-2 years with gradual tapering of steroids
- Regular monitoring is essential to manage potential side effects of long-term steroid use [ 1 , 1 ].
From the Research
Temporal Arteritis Symptoms
- Temporal arteritis is a condition characterized by inflammation of the blood vessels, specifically the temporal arteries [(2,3,4,5,6)].
- The symptoms of temporal arteritis can be controlled with corticosteroid treatment, with an initial dose of 35 mg prednisone daily being sufficient for most patients 2.
- However, flare-up rates upon corticosteroid reduction are high, especially in the first 24 months of treatment 2.
- Serious corticosteroid side effects are uncommon, but can occur, especially in elderly patients 5.
- The use of steroid-sparing medications, such as dapsone or methotrexate, may be considered to reduce the dosage of corticosteroids and minimize side effects 6.
Treatment and Management
- Corticosteroid treatment is the mainstay of treatment for temporal arteritis, with a treatment duration ranging from 1 to 5 years or more 4.
- The optimal corticosteroid dose regimen is still unclear, but a starting dose of 30-40 mg/d of prednisone and tapering to 10 mg/d within 6 months and to 5-7.5 mg/d within 1 year may be effective and less toxic 3.
- Adalimumab, a fully human recombinant IgG1, anti-TNF-alpha monoclonal antibody, has been reported to be effective in treating refractory temporal arteritis 4.
Complications and Side Effects
- Corticosteroid therapy can lead to serious side effects, including Gram-negative bacterial pneumonia, cystitis, and disseminated intravascular coagulation 5.
- Steroid-related side effects can occur in more than half of patients with temporal arteritis, and are associated with increased morbidity and may shorten life expectancy 6.