From the Guidelines
Temporal arteritis, also known as giant cell arteritis, is a medical emergency that requires immediate attention, and patients typically present with symptoms such as headache, scalp tenderness, jaw claudication, and vision changes, which can lead to permanent vision loss if left untreated. The clinical presentation of temporal arteritis is varied, but common symptoms include a new, severe headache typically on one side of the head near the temple, scalp tenderness when touching the temple area, jaw pain when chewing (jaw claudication), and vision changes including blurred vision, double vision, or sudden vision loss 1. Patients often experience fatigue, unexplained weight loss, fever, and shoulder or hip pain, with half of the patients reporting constitutional symptoms such as weight loss, night sweats, malaise, and fever 1.
Key Symptoms
- Headache: typically on one side of the head near the temple
- Scalp tenderness: when touching the temple area
- Jaw claudication: jaw pain when chewing
- Vision changes: blurred vision, double vision, or sudden vision loss
- Fatigue: unexplained weight loss, fever, and shoulder or hip pain
The condition is caused by inflammation of the temporal arteries, which supply blood to the head and brain, and it typically affects adults over 50, with women being more commonly affected than men, in a 3:2 ratio to men 1. Treatment with high-dose corticosteroids, usually prednisone 40-60mg daily, should be started immediately, even before confirming diagnosis, to prevent vision loss, and the dose is gradually tapered over months to years under medical supervision 1. A temporal artery biopsy is often performed to confirm the diagnosis, but treatment should not be delayed while waiting for biopsy results.
From the Research
Temporal Arteritis Symptoms
- Classic symptoms of temporal arteritis include:
- Polymyalgia rheumatica
- New-onset headache
- Jaw claudication
- Visual symptoms such as diplopia and amaurosis fugax 2
- Elevated erythrocyte sedimentation rate is a common laboratory finding in temporal arteritis 2
- Temporal artery biopsy is the gold standard for diagnosis 2, 3
- Visual symptoms are a medical emergency due to the risk of permanent vision loss 2, 3
Treatment and Management
- High-dose steroids are the mainstay of treatment for temporal arteritis 2, 3, 4
- The initial prednisone dosage should be chosen based on disease severity and comorbidities to reduce side effects 4
- A gradual tapering of the steroid dose should occur over at least 1 year 3
- Steroid-sparing agents may be considered if iatrogenic steroid complications occur 3
- TNF-alpha inhibitors such as adalimumab may be effective in treating refractory temporal arteritis 5