Temporal arthritis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Information, in part, from the Arthritis Foundation

This term is actually incorrect. The correct term is temporal arteritis.

This is a chronic inflammatory condition that affects the walls of blood vessels that carry blood from the heart to the rest of the body (arteries).

Temporal arteritis is also called giant cell arteritis and usually affects large arteries, typically the temporal artery, an artery on the side of the scalp.

This disorder affects about 1 of 1,000 people older than 50 and slightly more women than men. Its cause is unknown. Temporal arteritis often occurs with polymyalgia rheumatica.

The symptoms vary, depending on which arteries are affected. Typically, the large arteries to the head are affected, and a severe headache usually develops suddenly at the temples or back of the head. The blood vessels in the temple may feel swollen and bumpy. The scalp may feel painful when the hair is brushed. Double vision, blurred vision, large blind spots, blindness of one eye, or other eye problems may develop. The greatest danger is permanent blindness, which can occur suddenly if the blood supply to the optic nerve is blocked.

Characteristically, the jaw, chewing muscles, and tongue may hurt when eating or speaking. Other symptoms may include severe pain in the neck, shoulders, and hip, which also occurs in polymyalgia rheumatica.

Doctors base their diagnosis on the symptoms and a physical examination and confirm it by performing a biopsy of the temporal artery, located in the temple. Blood tests are also helpful, usually detecting anemia and a very high erythrocyte sedimentation rate (ESR), which indicates inflammation.

Because temporal arteritis causes blindness in 20% of untreated people, treatment must begin as soon as the disease is suspected. Treatment is often started even before a biopsy is performed; treatment does not affect the biopsy results as long as the biopsy is performed within several days of starting treatment. Prednisone, a corticosteroid, is highly effective. Initially, the dose is high—to stop the inflammation in the blood vessels; after several weeks, doctors slowly taper the dose if the person is improving. Some people can stop taking prednisone within a few years, but many need very low doses for many years to control symptoms and prevent blindness.

Patients who have difficulty with their temporal arteritis flaring during prednisone taper may require medicines such as methotrexate or azathioprine to help with further reduction of steroid dose.

Patients with temporal arteritis are prone to develop the usual complications of steroid treatment including cataracts, thinning of the skin, diabetes, and osteoporosis.

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