Arteritis (not to be confused with arthritis) is inflammation of
the walls of arteries, usually as a result of infection or auto-immune response.
- Temporal arteritis, also called giant cell arteritis, is specifically
arteritis of the vessels supplying the head, eyes and optic nerves, particularly the temporal
- Takayasu's arteritis affects the aorta and its branches.
- Polyarteritis nodosa affects the medium-sized arteries, especially those of renal,
coronary, hepatic and skeletal muscle systems.
Arteritis may be partially caused by the fungal pathogen Candida albicans.
Temporal arteritis almost always occurs in people over 50, and it becomes more common as
people age. About 20 out of 100,000 people over the age of 50 suffer from temporal arteritis. Women are
affected twice as often as men. Some authorities say that temporal arteritis is more common in Caucasians
(especially Scandinavians) than in people of other races. Close relatives of patients with temporal arteritis
may be more likely than others to get the disease.
Patients with temporal arteritis are diagnosed and overlap with a broader disorder called
giant cell arteritis. This can affect parts of the body in addition to the scalp, eyes, and jaw. Sometimes the
disease can cause restricted circulation to both arms or both legs, producing pain in the affected limbs. With
other blood vessels involved, patients with advanced forms of the disease may experience strokes or transient
ischemic attacks (TIA). These result in brief episodes of pain caused by decreased blood flow. Even heart
attacks are occasionally caused by giant cell arteritis.
Causes and symptoms
This disease is one of a group of diseases in which the linings of large- or medium-sized
blood vessels become inflamed. The elastic layer of these vessels is attacked by "giant" cells and chemicals
produced by the immune system. This reaction reduces blood flow through the blood vessels, and the limited
blood supply causes the symptoms.
The disease usually begins with "flu-like" symptoms, including a mild
fever (100-101°F), general body discomfort, and a persistent, dull headache. The scalp may be tender to
the touch over the affected blood vessels. Jaw muscles sometimes become painful when the patient chews.
As the disease progresses, more severe symptoms occur. These include blurred vision or
temporary blindness that typically lasts ten minutes or less. Eventually, permanent loss of vision can occur.
Transient ischemic attacks, strokes, and heart attacks may occur when the disease is far advanced.
Doctors from a number of specialties develop experience in diagnosing and treating temporal
arteritis. These include internists, who treat a broad range of diseases; rheumatologists, who focus on
rheumatic diseases; geriatricians, who treat older people; ophthalmologists, who treat eye and vision
disorders; neurologists, who treat headaches and problems of the optic nerve; and vascular surgeons, who treat
blood vessel problems.
The doctor will generally take a medical history first. The patient can help the doctor
tremendously by reviewing all symptoms—both major and minor—from the last two or three months. If possible, the
patient should ask family or close friends for help in recalling his/her ailments from recent months. Then the
doctor will conduct a complete physical examination. Often, he or she will detect a tender, swollen artery on
The doctor will order blood tests as well. A standard and inexpensive test called the
erythrocyte sedimentation rate (ESR or "sed" rate) is particularly helpful. Results from this test, which
measures inflammation in the body, will almost always be higher than normal. Tests of the red blood cells may
show mild anemia. Sometimes blood tests for liver function will also be abnormal.
The definitive diagnostic test is a temporal artery biopsy. A doctor will make one or more
tiny incisions under local anesthesia to remove samples of the suspect artery. Under the microscope, a
pathologist usually can identify the typical damage caused by temporal arteritis.
The mainstay of treatment is a course of corticosteroids (steroid hormones that have an
anti-inflammatory effect), usually prednisone. The initial prescription involves a fairly high dose of steroids
(40-60 mg/day) which is gradually tapered down to a maintenance dose. Because of the high incidence of blindness in
untreated cases, steroid therapy should be started immediately rather than waiting for biopsy results. Patients
typically take this maintenance dose for periods of one to three years. Sometimes nonsteroidal anti-inflammatory
drugs (NSAIDs) are prescribed for muscle aches or headaches, especially while steroid doses are being