Temporal Arteritis: Causes, Symptoms, Treatments And Prevention

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If you’ve been dealing with head pain or tenderness or perhaps jaw pain or vision problems, a condition called “temporal arteritis” might be the reason. Temporal arteritis is the most common type of inflammation of the blood vessels (vasculitis) in older adults, affecting 20 in 100,000 people over 50. Its incidence increases with age and is more common in females than males. 

What Is Temporal Arteritis?

Temporal arteritis, also called giant cell arteritis or Horton’s arteritis is characterized by swelling and constriction in the lining of the blood vessels that supply blood to the head, neck, upper body, and arms. It most commonly affects the blood vessels around the temples (temporal arteries). However, it can also affect larger vessels like the aorta and its branches. Ultimately, this condition poses serious health risks if left untreated. 

Temporal Arteritis Signs and Symptoms

The most common temporal arteritis symptoms are head pain and tenderness. This pain often affects both temples and is often persistent and severe. However, it may come and go, increasing and decreasing in severity. 

Other signs of temporal arteritis may include:

  • Scalp tenderness
  • Jaw pain when chewing or opening the mouth
  • Fatigue
  • Dizziness
  • Muscle aches or weakness 
  • Fever
  • Unexplained weight loss
  • Blurred or double vision
  • Sudden vision loss in one or both eye(s) 
  • Temporal artery enlargement or swelling

You may also experience pain and stiffness in your neck, hips, or shoulders. These symptoms are associated with polymyalgia rheumatica, which is a condition that nearly half of all patients with temporal arteritis also have. 

Temporal Arteritis Causes

What causes the inflammation of the blood vessels is still unknown. However, scientists think it is caused by an autoimmune disorder, which is when the immune system mistakenly attacks healthy tissue, such as the artery walls. Because the arteries carry blood from the heart to the rest of the body, swelling or inflammation from an immune response can greatly threaten your health.

Some viruses and bacteria are also suspected of triggering this condition. These include:

  • Herpes virus, a virus that can affect the mouth or genitals
  • Epstein-Barr virus, one of the most common viruses in humans that’s related to mono
  • Parvovirus B19, often known for causing rashes in children
  • Chlamydia, a sexually transmitted disease
  • Varicella-Zoster virus, the cause of chicken pox and shingles
  • Mycoplasma, a bacteria that can cause pneumonia
  • Parainfluenza virus, associated with respiratory illnesses, especially in children

Risk Factors

In addition to certain infections, other risk factors may make it more likely to develop this condition. 

  • Age: One of the most important risk factors for temporal arteritis is age. This condition does not typically affect people under 50 years of age. Most people with the condition are between the ages of 70 and 80. 
  • Sex: Sex can also be a risk factor. Females are two times more likely to develop temporal arteritis than males. 
  • Race: Race is another factor, with temporal arteritis affecting mainly White people, especially those of northern European descent. The incidence of this condition is higher in Scandinavian countries, such as Norway and Finland. 
  • Medical History: If there is a history of this condition in your family or if you have polymyalgia rheumatica, you have a higher risk of developing temporal arteritis.

Temporal Arteritis Diagnosis

Patient history is very important for diagnosing temporal arteritis because early symptoms are similar to other conditions. Your doctor will perform an exam and monitor your pulse for weakness. They will also examine your head for swelling at the temples and scalp tenderness. The temporal arteries may have a hard, cord-like appearance and feel. 

If your doctor suspects you may have temporal arteritis, they will also order tests that may include:

  • Biopsy: Your doctor may order a biopsy of the temporal artery so that it can be examined under a microscope. This biopsy is an outpatient procedure using local anesthesia, which is the best way to diagnose temporal arteritis.
  • Erythrocyte Sedimentation Rate: This blood test measures how quickly red blood cells settle to the bottom of a tube. If red cells settle very rapidly, this can indicate inflammation in the body.  
  • C-Reactive Protein: This protein is often elevated when there is inflammation in your body. A simple blood test can detect it. 
  • Hemoglobin Electrophoresis: This blood test checks for anemia by testing the hemoglobin levels in your blood. Hemoglobin is a protein in your red blood cells that carries oxygen. 
  • Doppler Ultrasound: This test uses sound waves to create images of blood flowing through your blood vessels. Your doctor may also schedule a magnetic resonance angiography (MRA), which combines an MRI with contrast material to produce detailed images of the blood vessels. 
  • Positron Emission Tomography (PET) Scan: If your doctor suspects the condition has affected larger arteries like the aorta, they may order a PET scan. This procedure uses an intravenous tracer with a very small amount of radioactive material. The PET scan can highlight areas of inflammation and produce detailed images of your blood vessels. 
  • Computed Tomography Angiography (CTA): This imaging test uses a type of X-ray linked with a computer to take images of your blood vessels after a special contrast dye has been intravenously injected. 

Temporal Arteritis Treatment

There is no cure for this condition, but effective treatment options exist. These include: 

High Doses of Corticosteroid Drugs

The main treatment is high doses of oral corticosteroid drugs like prednisone, which your doctor may prescribe even before a biopsy confirms that you have temporal arteritis.

Because quick treatment is vital to prevent vision loss, they may act rapidly and adjust medications once they get a confirmed diagnosis If temporal arteritis is highly suspected. However, if you have already had vision loss, it is not likely to improve.

The corticosteroids reduce the inflammation and swelling and are continued at high doses until the symptoms resolve, typically within a few weeks. Then, the doses are slowly tapered over a time span that varies based on the response, usually over 1 to 2 years. You may have to take the medication for up to 5 years in severe or recurrent cases.

Other Treatment Options

Add-on or adjunctive therapy options to help reduce the reliance on corticosteroids may also be something your doctor considers. These therapies are steroid-sparing agents that can prevent relapse, and they mainly include immunosuppressive drugs such as:

  • Cyclophosphamide
  • Interleukin (IL)-1 inhibitors like anakinra  
  • Leflunomide
  • Methotrexate 
  • Mycophenolate
  • T-cell inhibitors like abatacept
  • Tocilizumab (Actemra)
  • Tumor necrosis factor (TNF) inhibitors like etanercept and adalimumab

Aspirin can also reduce inflammation and the risk of blindness and stroke associated with temporal arteritis. 

Next Steps

If you are diagnosed with temporal arteritis, your outlook is good because the condition usually runs its course within 1 or 2 years. Proper medical care and medication can help manage symptoms immediately. However, ask your doctor about the possible side effects of the medications you have to take so that you know what to expect and can take the necessary precautions. 

You can also make a few lifestyle changes to help reduce your symptoms and prevent some of the negative effects of long-term corticosteroid use, such as: 

  • Quit smoking
  • Limit alcohol consumption
  • Reduce salt intake
  • Take calcium and vitamin D supplements to strengthen your bones
  • Get blood sugar checks
  • Do weight-bearing exercises

Schedule regular checkups with your doctor to watch for complications from temporal arteritis and the treatment. Sites like the Vasculitis Foundation can help you learn more about the condition and how to cope daily. 

Get support and learn as much as possible about temporal arteritis to minimize its effects on your life. 

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