Temporal Arteritis Is More Serious Than a Simple Headache
Temporal Arteritis Is More Serious Than a Simple Headache
Temporal arteritis is a systemic rheumatologic condition affecting the entire body. In the United States, 278 per 100,000 individuals are at increased risk of developing this disease, predominantly women of Northern European or Scandinavian ancestry. Prompt management is crucial to prevent complications, making the recognition of its signs and symptoms essential.
1. What Is Temporal Arteritis?
Temporal arteritis, also termed Horton's or giant cell arteritis, involves the inflammation of the lining of small and medium-sized blood vessels near the temples, including the superficial temporal arteries. Additional affected arteries include the carotid artery, which supplies blood to the brain, face, and neck; the subclavian artery, which supplies the thorax, arms, shoulders, and head; and the iliac arteries, which stem from the aorta to supply the sacroiliac region in the pelvis.
2. Symptoms: Headache and Scalp Pain
Temporal arteritis often causes severe, throbbing headaches that originate from the temples or the back of the head due to inflammation. Additionally, the scalp can become so tender that activities such as brushing one's hair or even light contact may result in significant pain.
3. Polymyalgia Rheumatica
Due to the influence of family history, medical professionals are investigating the genetic basis of temporal arteritis. A notable connection has been established between temporal arteritis and polymyalgia rheumatica (PMR), which is characterized by painful inflammation of the hip, shoulder, neck, and thigh muscles, exacerbating at night and in the mornings. Research indicates that 50% of individuals with giant cell arteritis (GCA) also suffer from PMR, and up to 20% of those with PMR are diagnosed with giant cell arteritis.
4. Double Vision
Temporal arteritis has profound impacts on vision, potentially influencing various visual pathways either suddenly or progressively. Giant cell arteritis causes diplopia, or double vision, in up to 20% of cases. The inflammation may result in reduced blood flow or complete obstruction within the ocular motor system, leading to episodes of skewed vision. In severe instances, this can cause permanent strabismus, commonly known as being cross-eyed.
5. Vision Loss
Vision impairment associated with temporal arteritis arises from multiple complications. One significant cause is the obstruction of the central retinal artery within the choroid, a region vital for supplying oxygen and nutrients to the retina, leading to severe vision loss. Furthermore, approximately seven percent of individuals with temporal arteritis experience an occipital lobe infarct, which is essentially a stroke affecting the occipital lobe.
6. Mouth Complications
Dentists sometimes misdiagnose jaw pain in individuals over 50, attributing it to temporomandibular joint disorder (TMJ) rather than temporal arteritis. Temporal arteritis involves the thickening and inflammation of blood vessels, which affects the jaw muscles, causing pain and cramping while chewing. In addition, patients may develop ischemic lesions on the tongue, potentially leading to tongue necrosis. These conditions can make eating difficult, often resulting in unintended weight loss.
7. Aortic Dissection
Aortic dissection occurs when a tear in the artery allows blood to flow between the layers of the vessel wall. This life-threatening condition is more likely to occur with an aortic aneurysm, as the increased size of the bulge heightens the risk of tearing. Significantly, research has shown that in patients with temporal arteritis, the risk of dissection in the ascending thoracic aorta, which is closer to the heart, persists irrespective of the aneurysm size.
8. Blood Tests and ESR
Based on the evaluation of symptoms, physicians may suspect temporal arteritis. To corroborate this suspicion, they measure the patient's erythrocyte sedimentation rate (ESR), which indicates the rate at which blood cells settle at the bottom of a test tube. Faster settling rates suggest higher levels of inflammation, thus supporting the initial diagnosis. Additionally, elevated C-reactive protein levels further confirm temporal arteritis. If the temporal arteries present a bumpy texture upon examination, a temporal artery biopsy may be performed. This procedure involves local anesthesia, a small incision, and the removal of a one-inch segment of the vessel for analysis.
9. Steroid Treatment
Individuals who receive prompt treatment for temporal arteritis before experiencing vision impairment have significantly better chances of recovery. In cases where symptoms progress to severe vision loss, treatment primarily aims to halt further deterioration rather than restore lost vision. The standard treatment for systemic vasculitis involves the use of corticosteroids, which rapidly alleviate symptoms and effectively manage inflammation.
10. Treatment Complications
The treatment for temporal arteritis involves the use of corticosteroids for a duration of two years or more. However, long-term corticosteroid therapy can inhibit bone reabsorption, an essential process for bone growth. To address this side effect, healthcare providers often recommend calcium and vitamin D supplements alongside the medication. Additionally, corticosteroids can cause sodium retention, resulting in hypertension. Consequently, patients undergoing this treatment regimen should have their blood pressure monitored regularly to detect and manage potential complications early.
