Temporal arteritis
Information about the causes, symptoms, and treatment of inflammation of the arteries of the neck and head.
Symptoms and Causes
Temporal arteritis, also known as Horton’s arteritis or giant cell arteritis, is a disease characterized by inflammation of medium- and large-caliber arteries, particularly those supplying the head and neck, such as the temporal arteries and other branches of the carotid artery.
It is caused by an abnormal immune system response, which leads to inflammation of the blood vessel wall and the formation of accumulations of inflammatory cells (granulomas). This inflammation may reduce or block blood flow, explaining many of its complications.
As it is a systemic disease, meaning it affects the entire body, it can involve any artery in the organism. However, it most frequently affects the temporal artery, which is responsible for supplying blood to the scalp, skull, and forehead. For this reason, it is referred to as temporal arteritis.
When detected early, Horton’s arteritis has a favorable prognosis, as life expectancy is not reduced in most cases. Nevertheless, complications or side effects associated with certain treatments may be linked to other conditions and a decreased quality of life.
Symptoms
The most common symptoms of temporal arteritis are:
- Severe and persistent headache.
- Jaw pain while chewing (jaw claudication), a highly characteristic symptom.
- Occasionally, pain in the face, neck, and shoulders.
- Increased sensitivity of the scalp.
- Fever.
- Asthenia: weakness and lack of energy that does not improve with rest.
- Unintentional weight loss.
- Vision loss or double vision, indicating involvement of the optic nerve.
Causes
The causes of temporal arteritis are unknown, although it is believed to be triggered by an abnormal immune response against the cells lining the arterial wall. This disorder is thought to occur as a result of natural cellular aging or a genetic predisposition.
Risk factors
The risk of developing temporal arteritis increases in the following cases:
- Age: it is more common after the age of 50, although the most severe symptoms usually appear after the age of 70.
- Sex: women are more likely to develop the disease.
- Polymyalgia rheumatica: an inflammatory disease that causes pain and muscle stiffness in the shoulders and hips.
- Family history.
Complications
If appropriate treatment is not followed, giant cell arteritis may lead to the following complications:
- Vascular damage in other areas of the body.
- Sudden blindness.
- Weakness of the ocular muscles.
- Aneurysm: bulging or dilation of a blood vessel.
- Stroke or cerebrovascular accident: reduction or blockage of blood flow to the brain.
- Transient ischemic attack: a stroke lasting only a few minutes.
Prevention
Temporal arteritis cannot be prevented.
Which specialist treats temporal arteritis?
Temporal arteritis is usually diagnosed and treated within the specialty of internal medicine. The involvement of specialists in neurology and ophthalmology may also be required.
Diagnosis
The diagnosis of temporal arteritis is clinical, as there are no specific tests to definitively detect it. The diagnostic process usually includes the following examinations:
- Medical interview and clinical history: comprehensive information is collected regarding the patient’s medical and family history, lifestyle, general health status, and presenting symptoms.
- Physical examination: palpation is used to assess the pulse of the temporal artery, which is reduced in patients with the disease.
- Blood tests: when the diagnosis is positive, the following findings are detected:
- Elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The erythrocyte sedimentation rate measures the time it takes for red blood cells to settle at the bottom of a test tube over one hour; an increased rate indicates the presence of inflammation in the body.
- Signs of anemia: low levels of hemoglobin, red blood cells, and hematocrit.
To assess the condition of the arteries once the disease has been diagnosed or to evaluate treatment efficacy, the following tests are useful:
- Doppler ultrasound: sound waves are used to obtain moving images of blood flow.
- In some cases, imaging techniques such as magnetic resonance imaging (MRI) or PET-CT may be used to evaluate large vessels.
- Temporal artery biopsy: a sample of arterial tissue is obtained for laboratory analysis. Microscopic examination reveals abnormally large cells, which is why the disease is known as giant cell arteritis.
Treatment
The treatment of temporal arteritis is pharmacological. Glucocorticoids rapidly reduce symptoms and prevent the development of complications.
To achieve the expected results, medication must be taken over a prolonged period, which may last several years. As glucocorticoids can cause serious side effects—such as osteoporosis, hypertension, muscle weakness, weight gain, or bruising—regular follow-up visits are necessary to ensure the patient’s overall health.
In patients at high risk of relapse or adverse effects, immunosuppressive or biologic drugs may be used as adjunctive therapy, always prescribed by a specialist.
