Temporal Arteritis
Caused by granulomatous inflammation of medium- and large-sized arteries. Most commonly affects branches of the external carotid artery, especially the temporal artery. Strongly associated with Polymyalgia Rheumatica (PMR)
Older woman with headache, jaw pain while chewing, scalp tenderness, and elevated ESR - treat immediately with steroids to prevent vision loss, even before biopsy.
Epidemiology
- Age > 50 (almost always)
- More common in women
- Northern European descent
Clinical Features
- New-onset headache (temporal or unilateral)
- Scalp tenderness (e.g. pain when brushing hair)
- Jaw claudication (most specific symptom)
- Visual symptoms: transient vision loss → can progress to permanent blindness
- Constitutional symptoms: fever, fatigue, weight loss
- ± Polymyalgia rheumatica: proximal muscle stiffness (shoulders/hips) without true weakness
Diagnosis
- ESR > 50 (often >100)
- ↑ CRP
- Normocytic anemia, thrombocytosis
- Temporal artery biopsy (gold standard): granulomatous inflammation with multinucleated giant cells
- Skip lesions may be present → false negatives possible
Treatment
- Immediate high-dose corticosteroids (e.g. prednisone 40-60 mg/day) before biopsy to prevent vision loss
- IV methylprednisolone if visual symptoms are present
- Continue steroids for months; taper slowly
- Monitor ESR/CRP to guide taper
- Aspirin may reduce risk of vision loss/stroke
Complications
- Irreversible blindness (from anterior ischemic optic neuropathy)
- Aortic aneurysm/dissection (especially thoracic) - monitor with serial imaging
- Start steroids → then biopsy within 1-2 weeks (histologic findings persist for a while)
- Always ask about Polymyalgia Rheumatica symptoms in patients with temporal arteritis