Temporal Arteritis by drdoc on-line

 

Temporal arteritis is an inflammatory disease affecting blood vessels with a granulomatous type of inflammation and resulting in a blockage of blood supply to the area served by the vessels.

It is seen especially in the elderly and usually mean age 70 yrs. .
It may be associated with polymyalgia rheumatica.

Symptoms are usually fatigue malaise Weight loss Headache -usually temporal and present in approx. 66% of cases.
Headache is the most common symptom and is present in two thirds or more of patients. It usually begins early in the course of the disease and may be the presenting symptom. The pain is severe and localized to the temple. There can be one or both sides affected.

 Scalp tenderness is common. The local vessels are thickened, and tender . Occasionally they are visible.

Visual disturbances have been seen in 25–50% of cases.

Blindness is the most serious and irreversible feature. This can be sudden, painless and permanent. Involvement of the second eye can occur. Blindness may be the initial presentation of giant cell

Other symptoms include jaw discomfort when eating - due to a shortage in blood to the muscles of mastication (chewing), as a consequence of blockage of the affected blood vessels.

Management

Corticosteroids are critical in the treatment of giant cell arteritis; they reduce the incidence of blindness and rapidly relieve symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) will lessen the painful symptoms, but they do not prevent the blindness or vascular problems. The response occurs within days.

Initially, the Corticosteroids should be given in a sufficient dosage to control the disease and then maintained at the lowest dose which will control the symptoms and lower the ESR.
A biopsy of the temporal arteries is preferable, but treatment should not be withheld if biopsy is unavailable.
A strong clinical diagnosis with a normal biopsy should also not be a reason not to treat as the vessels frequently have "skip lesions" with normal artery between abnormal areas - so a false negative biopsy is not uncommon. In fact we recommend biopsy of both sides even if symptoms are not present on the opposite side.

Temporal artery biopsy does not seem helpful in predicting outcome.

We use a starting dose of 40-60 mg of prednisone and cater the dose to individual patients.
We continue this dose for the first month and then start to reduce down to approx. 20 mg by 2 months and then a slow withdrawal thereafter depending on symptoms and the ESR.

Most patients are on steroid approx. 2 years.

Unfortunately there are many side effects of high dose steroids. These include:

Weight gain
skin thinning
Hypertension
Cataracts
Bruising of the skin
Diabetes
Facial and truncal / torso weight gain
Psychological side effects including depression anxiety and occasionally psychosis

Since the condition is urgent with such severe potential consequence the patient must understand WHY the doctor is initiating these doses.

Steroid sparing drugs such as methotrexate have been used to try reduce the cortisone requirements and doses.

 

 

 

 

arteritis der paele

 

Evidence of temporal arteritis: painting by Jan Van Eyck (c. 1385–1440),


entitled The Virgin with Canon Van der Paele, 1436.
Notice the prominent arteries on the temples of the bishop.

 

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