Temporal Arteritis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Temporal arteritis, also known as giant cell arteritis (GCA), is an inflammatory disease of the large and medium-sized arteries, primarily affecting the branches of the external carotid artery. It is a medical emergency that can lead to blindness if not treated promptly.

Aetiology

The exact cause of temporal arteritis is unknown, but it is believed to be an autoimmune condition where the body's immune system mistakenly attacks its own arteries, causing inflammation.

Pathophysiology

Inflammation of the arterial walls leads to the formation of giant cells. This inflammation causes narrowing or occlusion of the affected arteries, reducing blood flow and leading to ischaemia of tissues. The temporal arteries, aorta, and other large vessels are commonly involved.

Risk Factors

• Age (most common in individuals over 50)
• Gender (more common in females)
• Ethnicity (more common in people of Northern European descent)
• Polymyalgia rheumatica
• Genetic predisposition

Signs and Symptoms

Common signs and symptoms of temporal arteritis include:

• Severe, persistent headache, often on one side of the head
• Scalp tenderness
• Jaw claudication (pain in the jaw when chewing)
• Visual disturbances (e.g., blurred vision, double vision, or sudden vision loss)
• Fever
• Fatigue
• Weight loss
• Muscle aches (often associated with polymyalgia rheumatica)

Investigations

• Clinical history and physical examination
• Blood tests:
  • Erythrocyte sedimentation rate (ESR) - typically elevated
  • C-reactive protein (CRP) - typically elevated
  • Full blood count - may show anaemia and thrombocytosis
• Temporal artery biopsy to confirm diagnosis
• Imaging studies (e.g., ultrasound, MRI, or PET scan) to assess the extent of arterial involvement

Management

Primary Care Management

• Confirm with supervisor for immediate initiation of corticosteroids: Prednisolone (40-60 mg daily) should be started as soon as temporal arteritis is suspected to prevent vision loss
• Need for urgent hospital admission: Immediate referral to hospital for further evaluation and management
• Referral to a rheumatologist

Specialist Management

• Long-term corticosteroid therapy: Gradual tapering of corticosteroids over months to years, guided by clinical response and inflammatory markers
• Adjunctive immunosuppressive therapy: Medications such as methotrexate or tocilizumab may be used to reduce steroid dependence
• Regular monitoring for complications of long-term steroid use (e.g., osteoporosis, diabetes, hypertension)
• Management of associated conditions such as polymyalgia rheumatica
• Regular follow-up with a rheumatologist and ophthalmologist to monitor disease activity and visual health

References

1. NICE. (2024). Temporal Arteritis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Giant Cell Arteritis (Temporal Arteritis). Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Giant Cell Arteritis: Diagnosis and Management. Retrieved from BMJ
4. American College of Rheumatology (ACR). (2021). Guidelines for the Management of Giant Cell Arteritis. Retrieved from ACR

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