(Giant Cell Arteritis
Temporal arteritis, is known as giant cell arteritis, it is an autoimmune inflammatory condition affecting the medium-sized blood vessels that supply the head, eyes, and optic nerves. The disease usually affects people over age of sixty and causes the vessels in the temple and scalp to become painful tender and swollen. Women are approximately 4 times more likely to suffer from this disease then men.
concern with temporal arteritis is vision
loss, although if allowed to progress, it
may affect arteries in other areas of the
body. This condition is potentially
vision threatening, however, if treated
promptly, permanent vision loss can be
prevented. Vision is threatened when
the inflamed arteries obstruct blood flow to
the eyes and
optic nerves. If untreated,
permanent vision loss can occur from oxygen
deprivation to the retina and optic nerve.
Signs and Symptoms
Patients with temporal arteritis usually notice visual symptoms in one eye at first, but as many as 50% may notice symptoms in the fellow eye within days if the condition is untreated.
- Tenderness of scalp (combing hair may be painful)
- Pain in temple area (may be excruciating)
Transient blurred vision
Loss of appetite
Jaw soreness, especially when chewing food
The disorder may develop along with or after polymyalgia rheumatica. Giant cell arteritis is almost always seen in people over age 50, but it may sometimes occur in younger people. It is rare in people of African descent. There is some evidence that it runs in families
Detection and Diagnosis
Looking in the Fundus of the EYE
You see a pale disc in the center
When temporal arteritis is suspected, the doctor will order blood tests including a erythrocyte (red blood cell) sedimentation rate (ESR) and C-reactive protein test. The ESR test measures the time it takes for the erythrocytes to collect in the bottom of a test tube. The sediment layer of erythrocytes is measured in millimeters and recorded. An abnormally high ESR is indicative of active inflammation.
C-reactive protein is produced in the liver. This protein is released when the body responds to an injury or any other event that signals inflammation. C-reactive protein is measured with a blood test.
A biopsy of the temporal artery is usually recommended. No need to do Biopsy if ESR is elevated just start treatment asap.
inflammation seen on skin Biopsy
Giant cells in Biopsy
The ESR usually is 60-90.
procedure is performed with local
anesthesia. A small section of the
temporal artery is removed and examined
under magnification for inflammatory cells.
This test allows doctors to definitively
diagnose temporal arteritis. Cidpusa has
many reports of biopsy results which came
back negative while the patient had
arteritis. This can be seen in burnt out
disease where after inflammation atrophy has
The ophthalmologist often works in conjunction with the patient's internist to treat this disease. The primary treatment for the disease is oral steroid medication to reduce the inflammatory process. Most patients notice an improvement in their symptoms within several days. In some cases, a long-term maintenance dosage of the steroid is required. Steroid can be given I/V . Monitor with the sed rate the lower it is lower the steroids. Prednisone is preferred starting dose is 40 mg daily orally but consider giving Solumedrol one gram I/V at once and daily for three days.
to be checked for infections like
CMV, herpes virus and treated in case of
Mycoplasma or as a default antibiotic with
Doxycycline. We have seen reversal in three
weeks.The antibiotic is based upon CIDPUSA own research and we have seen a
faster response to good results.
For detailed management of this disease see this link