Temporal Arteritis: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Outlook

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woman hold her head that suffering from temporal arteritis

1Overview

The body works because the cells and tissues receive the needed oxygen and nutrients brought by the blood. The blood flows through many vessels called arteries and veins. When there are abnormalities in the blood vessels, these may lead to various diseases and possibly, serious complications as a result of hypoxia, or the lack of oxygen supply.

The blood arteries carry oxygenated or clean blood to the various parts of the body. When the blood containing oxygen is blocked due to blood vessel problems, the vital organs in the body will not receive the needed oxygen to function. If the heart, for instance, does not receive oxygen, it will lead to myocardial infarction and the death of the heart muscles. If the brain does not receive oxygen, this will lead to stroke.

In the body, there are important arteries that supply blood to vital organs. The heart is supplied by the coronary arteries while the brain contains the temporal arteries. One condition that affects the blood supply to the brain is temporal arteritis, which is also called as cranial arteritis or giant cell arteritis.

Temporal arteritis is an inflammation of the arterial lining and it usually affects the arteries in the head. This condition often causes symptoms like vision problems, jaw pain, scalp tenderness and headaches.

According to the Journal of Arthritis and Rheumatology, about 228,000 individuals in the United States are living with temporal arteritis. People who are over 50 years old are at a higher risk of developing the condition.

2Symptoms

A headacheThis symptom occurs in an estimated two-thirds of people diagnosed with the condition. Temporal arteritis headache usually develops suddenly over a day or so. However, in some cases, the headache will develop slowly over several days or weeks. A headache can occur on just one side of the head or on both sides.

Scalp tenderness – The tenderness of the scalp over the affected arteries is common among patients with the condition. The patient can even feel the swollen temporal arteries just under the skin.

Pain in the jaw (jaw claudication) – People with temporal arteritis have limited blood supply flowing through the temporal arteries. Since the arteries are inflamed, the passageway is narrowed, reducing the blood supply to some areas. As a result, there is jaw pain when eating, taking or merely opening the mouth.

Vision problemsVisual disturbances such as complete or partial blindness in one or both eyes happens in up to one in five affected individuals. Sometimes, this is the early symptom of the condition. In some people, they report a feeling of a shade covering the eyes and eventually, it may lead to permanent vision loss. The worse thing is, when the condition is not treated right away, the second eye will more likely become affected in just one to two weeks.

The other general signs and symptoms of temporal arteritis include:

  • Jaw pain when you open your mouth or chew
  • Fatigue
  • Fever
  • Unexplained weight loss
  • Double vision
  • Weakness
  • Anorexia
  • Depression

When to call a doctor?

If the patient will experience severe pain or any problems with the symptoms, consulting with a doctor is important. This will help manage the condition before permanent complications will develop such as blindness.

3Causes

The exact cause of the condition is still unknown but many studies have tied temporal arteritis to the body’s autoimmune response. In some cases, certain gene and gene variations may heighten a person’s risk of developing temporal arteritis.

In temporal arteritis or giant cell arteritis, the arterial lining becomes inflamed. As a result, the swelling narrows the blood vessels, impeding the flow of blood. Hence, the transport of oxygen and vital nutrients to the body’s tissues is altered.

Some studies have also linked the use of excessive doses of antibiotics and some severe infections to the development of this condition. The condition can’t be prevented but early detection is important to minimize the known complications and slow the progression of the disease.

4Risk Factors

Temporal arteritis can affect anyone, however, some doctors have identified factors that may increase the risk of developing the illness. These include:

Polymyalgia rheumatica – The risk of having temporal arteritis increases when the patient has polymyalgia rheumatica.

Age – Older people are at a heightened risk of developing this illness. It rarely affects those who are 50 years old and below. A majority of patients may experience the symptoms between the ages of 70 and 80 years.

Geographic location and race – Giant cell arteritis or temporal arteritis is more common in people who are White living in the North European region. It also affects people of Scandinavian descent more than others.

Gender – Women are more twice more likely to acquire temporal arteritis.

Genetics – People who have a family history of the condition are at a higher risk of developing temporal arteritis.

5Complications

If the condition is left untreated, it may lead to serious complications including:

Permanent blindness in one or both eyes – If the affected artery becomes inflamed, the blood supply is limited or blocked. Since the temporal arteries are connected to the small arteritis supplying blood to the eyes, when the supply of oxygen is blocked, it can cause permanent blindness. Once blindness occurs, there is a little chance of recovering it, even with treatment.

An aortic aneurysmAn aneurysm is a bulge that forms when the blood vessel becomes weak. This usually happens in the largest artery in the body, the aorta. An aortic aneurysm is fatal because it could lead to internal bleeding.

The other complications include a heart attack, stroke, nerve damage and hearing loss.

6Diagnosis

Temporal arteritis can be hard to diagnose since its early symptoms are similar to other conditions in the body. However, there are ways to diagnose the condition:

Complete physical exam and medical history interview – If the doctor suspects a giant cell arteritis or temporal arteritis, he will ask the patient about the symptoms felt. Moreover, he may conduct a complete physical exam including the examination of the head. One of the signs he may look for is the noticeably swollen arteries on the temples.

Blood tests – Blood tests can be used to diagnose temporal arteritis and these include erythrocyte sedimentation rate. This test helps detect inflammation in the body. Another test that can be requested is C-reaction protein (CRP test). This measures the levels of CRP, a substance in the liver that is produced when there is inflammation in the body.

Eye Tests – If the patient has vision problems, the doctor will most likely request a series of eye tests to identify if there is limited blood supply to the eyes. Moreover, eye tests will determine the severity of the eye problem.

Biopsy – One of the best ways to confirm a diagnosis of temporal arteritis is through a biopsy, wherein a small tissue sample is taken from the temporal artery. When the tissue is examined under the microscope, it should show signs of inflammation.

Imaging tests – Imaging tests can also be recommended to take 3D photos of the head including the veins and arteries. Three imaging tests are usually recommended such as magnetic resonance angiography (MRA), positron emission tomography (PET) scan and Doppler ultrasound.

7Treatment

The main treatment of temporal arteritis is to reduce the inflammation. Doctors usually recommend medicines that can reduce inflammation. However, medicines should only be recommended by licensed doctors and patients are discouraged to self-medicate.

Medical treatment

Steroids

The preferred treatment for temporal arteritis is the use of steroids or corticosteroids. The choice of medicine is prednisolone.

When there is an impending vision loss, the doctor needs to initiate immediate treatment to prevent blindness. He will usually start the medication even before confirming the diagnosis via biopsy.

The medicine is usually taken for about one to two years and after the initial high doses of the medicine, the doctor may start to taper the dose slowly. Don’t just stop taking medicine suddenly unless the doctor tells you and it is safe to do so. Abruptly stopping the medicine may lead to feeling very ill.

However, steroid has been tied to some severe side effects like increased blood pressure, osteoporosis, and muscle weakness. The doctor may prescribe vitamin D and calcium supplements to counter these adverse effects.

Steroids have also been linked to the suppression of the immune system. Hence, taking care of your health is important to reduce the risk of acquiring infections.

The other signs and symptoms of steroids include:

Low-dose aspirin

The doctors may also prescribe a low-dose aspirin for people with a history of temporal arteritis. The drug can help prevent the complications tied to the condition, such as stroke or heart attack.

When a doctor prescribes steroids and low-dose aspirin to a patient, he should prescribe a medicine called omeprazole. This medicine is a proton-pump inhibitor and it can help protect from stomach ulcers since both aspirin and steroids are gastric irritants.

Immunosuppressant

Some individuals diagnosed with temporal arteritis may benefit from certain immunosuppressants. These drugs like methotrexate or leflunomide are used to suppress the immune system to reduce inflammation. The common side effects of these medicines are diarrhea, skin rashes and vomiting and nausea.

8Outlook

If the disease is treated accordingly and properly, the complications will be prevented. It is important to detect the disease early to prevent serious and life-threatening complications such as permanent blindness, stroke, and heart attack.