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Temporal Arteritis

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VOL: 99, ISSUE: 32, PAGE NO: 26


- Arteritis is a progressive, inflammatory disorder affecting any medium-sized artery, most commonly the temporal artery.



- When the condition is generalised it is often referred to as giant cell arteritis, but when it affects arteries within the scalp it is called temporal or cranial arteritis.



- The affected artery walls thicken and are infiltrated by ‘giant cells’ - multinucleate cells formed in response to an inflammatory attack on the artery wall. The arterial lumen narrows, resulting in ischaemia and pain.



- Temporal arteritis is a rare condition, with an incidence rate of 1-2 per 10,000 people and is closely associated with polymyalgia rheumatica (a chronic, episodic, inflammatory disease of the large arteries).



- It is rarely seen in people under 50 years of age and the mean age of onset is 70 years.



- Women are more likely to be affected than men and it is rarely seen in individuals of Afro-Carribean or Asian origin.



- Severe headache (present in 85 per cent of patients) with throbbing, boring or sharp pain in the temporal area.



- Transient or permanent sudden vision loss, normally in one eye. However, the second eye is usually affected within two or three weeks if untreated.



- Jaw claudication, especially when chewing or speaking.



- Scalp tenderness.



- Fever.



- Depression.



- Weight loss.



- Loss of appetite.



- Rheumatic pain.



- Fatigue.



- There is no known cause, but ageing seems to cause the immune system to attack the arteries.



The main concern is vision loss or blindness. However, if allowed to progress temporal arteritis can affect arteries in other parts of the body and can cause:



- Thoracic or abdominal aneurysms;



- Stroke;



- Myocardial infarction.



- Erythrocyte sedimentation rate.



- Temporal artery biopsy performed under local anaesthetic.



- A course of corticosteroids (usually prednisolone) is effective if administered promptly. Treatment should continue until remission of the disease is seen. Doses should then be tapered gradually to a maintenance dose.



- Symptoms often diminish within one month of starting treatment. However, relapse is common if treatment is stopped prematurely. Many patients need treatment for at least one to two years and in some situations it can last indefinitely.



- Loss of sight is hard to recover, but if treatment is prompt then partial sight can be restored.



- Nonsteroidal anti-inflammatory drugs (NSAIDs) are sometimes prescribed for muscle aches or headaches when the doses of corticosteroids are being reduced.



- Aspirin may be a useful prophylactic treatment but it is not suitable for every patient.



- As many eye conditions are asymptomatic it is essential to emphasise the importance of having regular eye tests.



- Any changes in sight must be followed up immediately as most major causes of blindness can be treated if identified at an early stage.



- Current research is looking at genetic factors, immune system abnormalities and environmental factors that may play a role in temporal arteritis.





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