TEMPORAL ARTERITIS

Temporal arteritis, also known as the Giant cell arteritis, is a disease of the immune system that leads to the proliferation of the inflammatory cells in the vessel wall, which will eventually cause its inflammation.

It is called temporal arteritis because the arteries around the temples are usually affected.

The condition is one of the most common types of inflammation of the arteries and veins (vasculitis).

Temporal arteritis is always associated with stiffness, aching pain in the muscles of the neck, shoulders, lower back, hips and thighs.

Symptoms of giant cell arteritis 

The most common sign and symptom of giant cell arteritis (GCA) is headache, fever, anemia, increase ESR.  Patient may also experience malaise, fatigue, weight loss, and bone pain.

Headache

It most often affects the front or side of the head (temples), but can also affect the back or top of the head, or behind the ears. The headache noted can be very painful that painkillers are not effective.

Jaw pain

Although less common, people with giant cell arteritis may also experience jaw pain (jaw claudication) and problems with vision. Jaw pain typically occurs when chewing or talking. The pain usually stops when the jaw is rested. In some cases, the pain is felt in the tongue.

Vision problems

Vision problems affect about one in five people with giant cell arteritis. This can be in one or both eyes. It’s been described as like having a shade covering your eyes.

Diagnosing giant cell arteritis 

Giant cell arteritis is difficult to diagnose because its early symptoms resemble those of many common conditions. For this reason, your doctor will try to rule out other possible causes of your problem by asking for questions and doing thorough physical examination.

This is because giant cell arteritis can cause physical signs, such as noticeably swollen arteries in your temples.

Other than the history taking and the thorough physical examination, the doctor may do other tests such as:

  • Blood tests. The doctor may request for blood tests that will analyze for the level of inflammatory cells in the body, these are the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). These tests are useful for assessing conditions associated with short- or long-term inflammation.
  • Eye tests. The ophthalmologist will check your eyes for changes associated with giant cell arteritis, such as bleeding or swelling at the site of your optic nerve (the nerve at the back of the eye that transmits signals to the brain).
  • Temporal artery biopsy. The doctor may also do biopsy to check for damage and inflammation of the lining of the arteries.  The doctor will get a small tissue sample in the affected area and the pathologist will examine the tissue under the microscope.
  • Cranial ultrasound. Research has shown cranial ultrasound is a simple and accurate diagnostic test for giant cell arteritis.

Accurately diagnosing giant cell arteritis is very important because it ensures people with the condition continue to receive steroid treatment to help prevent visual impairment.

This also ensures that those who no longer have the condition don’t continue receiving steroid treatment unnecessarily. Long-term steroid use can cause side effects.

 

Treatment

Treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.

Prednisolone  

The route of the steroid depends on whether vision is at risk.  For patients whose vision is not at risk, Prednisone tablets or capsules are prescribed, starting in a high dose and eventually tapered down every two to four weeks, depending on how well the patient responds to the treatment.  If vision is at risk, prednisone is give via injection, after this, prednisone tablets will be prescribed.

The patient may need to take prednisolone for up to two years to prevent symptoms from returning.

Side effects of steroids intake

Steroid may affect the mental health of the patient and may also lead to other significant side effects if used for a very long time. For example, you may feel very depressed and suicidal, very anxious, or very confused. Some people also experience hallucinations.

Other side effects of prednisolone include:

  • increased appetite, which often leads to weight gain
  • increased blood pressure
  • mood changes, such as becoming aggressive or irritable with people
  • weakening of the bones (osteoporosis)
  • stomach ulcers
  • increased risk of infection – particularly to the virus that causes chickenpox and shingles (varicella-zoster virus).

Low-dose aspirin

Low-dose aspirin is being recommended for people with a history of giant cell arteritis to prevent complications of giant cell arteritis, and also to prevent formation of thrombus on the blood vessel.

Proton Pump Inhibitors

If a patient is prescribed steroids for a long period of time and at a high dose, they are usually prescribed with PPIs to prevent complications, such as, stomach ulcers caused by the steroids intake.

Immunosuppressants

Immunosuppressants are a type of medication used to suppress the immune system (the body’s defense against infection and illness). Using immunosuppressants can allow steroid medication to be reduced, and can help prevent the condition recurring.

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