World Library  
Flag as Inappropriate
Email this Article

Temporal arteritis

Article Id: WHEBN0020965310
Reproduction Date:

Title: Temporal arteritis  
Author: World Heritage Encyclopedia
Language: English
Subject: List of neurological conditions and disorders, Rheumatology, Vasculitis, List of systemic diseases with ocular manifestations, Night sweats, Autoimmune disease
Collection:
Publisher: World Heritage Encyclopedia
Publication
Date:
 

Temporal arteritis

Giant-cell arteritis
Classification and external resources
10 9 OMIM DiseasesDB MedlinePlus eMedicine MeSH D013700

Giant-cell arteritis (GCA or temporal arteritis or cranial arteritis) or Horton disease is an inflammatory disease of blood vessels most commonly involving large and medium arteries of the head, predominantly the branches of the external carotid artery. It is a form of vasculitis.

The name (giant cell arteritis) reflects the type of inflammatory cell involved[1] as seen on a biopsy.

The terms "giant-cell arteritis" and "temporal arteritis" are sometimes used interchangeably, because of the frequent involvement of the temporal artery. However, it can involve other large vessels (such as the aorta in "giant-cell aortitis"[2]). Giant-cell arteritis of the temporal artery is referred to as "temporal arteritis," and is also known as "cranial arteritis" and "Horton's disease."[3]:840

Signs and symptoms

It is more common in women than in men by a ratio of 2:1 and more common in those of Northern European descent, as well as those residing at higher latitudes. The mean age of onset is >55 years, and it is rare in those less than 55 years of age.

People present with:

The inflammation may affect blood supply to the eye and blurred vision or sudden blindness may occur. In 76% of cases involving the eye, the ophthalmic artery is involved causing arteritic anterior ischemic optic neuropathy.[7] Loss of vision in both eyes may occur very abruptly and this disease is therefore a medical emergency.

Associated conditions

The disorder may coexist (in a half of cases) with polymyalgia rheumatica (PMR), which is characterized by sudden onset of pain and stiffness in muscles (pelvis, shoulder) of the body and is seen in the elderly. GCA and PMR are so closely linked that they are often considered to be different manifestations of the same disease process. Other diseases related with temporal arteritis are systemic lupus erythematosus, rheumatoid arthritis, and severe infections.

Giant-cell arteritis can involve branches of the aorta as well leading to aortic aneurysm. For this reason patients should be followed with serial chest X-rays

Diagnosis

Physical exam

  • Palpation of the head reveals prominent temporal arteries with or without pulsation.
  • The temporal area may be tender.
  • Decreased pulses may be found throughout the body
  • Evidence of ischemia may be noted on fundal exam.

Laboratory tests

Biopsy

The gold standard for diagnosing temporal arteritis is biopsy, which involves removing a small part of the vessel and examining it microscopically for giant cells infiltrating the tissue. Since the blood vessels are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. Unilateral biopsy of a 1.5–3 cm length is 85-90% sensitive (1 cm is the minimum).[8] So, a negative result does not definitely rule out the diagnosis. Thus, currently biopsy is only considered confirmatory for the clinical diagnosis, or one of diagnostic criteria.[6]

Imaging studies

Radiological examination of the temporal artery with ultrasound yields a halo sign. Contrast enhanced brain MRI and CT is generally negative in this disorder. Recent studies have shown that 3T MRI using super high resolution imaging and contrast injection can non-invasively diagnose this disorder with high specificity and sensitivity.[9]

Treatment

Corticosteroids, typically high-dose prednisone (1 mg/kg/day), must be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy) to prevent irreversible blindness secondary to ophthalmic artery occlusion. Steroids do not prevent the diagnosis from later being confirmed by biopsy, although certain changes in the histology may be observed towards the end of the first week of treatment and are more difficult to identify after a couple of months.[10] The dose of prednisone is lowered after 2–4 weeks, and slowly tapered over 9–12 months. Tapering may require two or more years. Oral steroids are at least as effective as intravenous steroids,[11] except in the treatment of acute visual loss where intravenous steroids appear to offer significant benefit over oral steroids.[12]

References

External links

  • University of Iowa
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases
  • Temporal (Giant Cell) Arteritis - PrimeHealthChannel.com
  • PMRGCAuk - UK charity offering support, raising awareness, promoting research
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.
 


Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.