eSurgery

GIANT CELL ARTERITIS (Temporal arteritis)

This is a rare condition affecting the  arteries in the head. Usually affecting people over 50. Twice as common in females than males. Commoner in Caucasians. And associated with polymyalgia rheumatica(PMR)

What is the condition?

This condition is due to the inflammation of the artery in particular the temporal artery in the head. We do not know what causes the inflammation.

What are the symptoms?

Headache – especially if it is worse on the temple or occiput; usually described by patients as different from their previous headaches

Symptoms of polymyalgia rheumatica (PMR) – aches and stiffenss of shoulders and hips

General constitutional symptoms – fever, tiredness, loss of weight

Local symptoms on the temporal artery – tender scalp(eg painful on combing hair), thickened palpable temporal artery

Jaw claudication – pain on chewing

Visual disturbances – eg visual loss, double vision

What other conditions can mimic this?

Other types of vasculiltis

Infection

Malignancy

Cervical spondylosis

Investigations

1. Blood test – ESR/CRP (elevated)

2. The gold standard is temporal artery biopsy – this can be performed under local anaesthesia in theatre. A cut is made over the palpable temporal artery and at segment of the artery is cut out after tying up the ends. The artery specimen is sent to the pathology lab for testing. (Histology findings: Multinucleate giant cells)

Treatment

Steroids – high does for 2 to 4 weeks(typically 40-60mg/day) And then tapered off. Higher doses may be needed if there are visual symptoms.

Author’s note: In my practice, the rheumatologist refers the patients with suspected giant cell arteritis to me to perform the temporal artery biopsy.

Disclaimer:

This article does not constitute medical advice

You should see a qualified medical practitioner for a formal opinion.