Clinical picture
Symptoms of temporal arteritis are:
- headache;
- transient visual impairment (eg, double vision);
- sudden loss of vision of one eye;
- spastic pain in the jaw or ear when chewing - observed in 50% of patients;
- tenderness of the skin of the scalp.
Approximately in a quarter of cases, temporal arteritis accompanies rheumatic polymyalgia (a disease characterized by symmetrical pain and stiffness of the muscles of the shoulder and pelvic girdle). Sometimes the clinical picture of the disease is fuzzy, with the prevalence of such symptoms as fatigue, depression, prolonged fever, loss of weight and appetite. Early diagnosis of temporal arteritis significantly reduces the risk of developing blindness. The basis for the diagnosis is usually external examination data and blood test results. Upon examination, the physician draws attention to the soreness in the temporal artery and the decrease or absence of its pulsation.
Examination
- Inspection of the oculist.
- Blood test - usually anemia of mild degree and elevation of platelets is detected. Diagnostically important sign is a significant increase in ESR (sedimentation rate of erythrocytes) more than 50 ml / h. However, in about 10% of patients, ESR can remain within normal limits, making it difficult to diagnose.
- Artery wall biopsy. To confirm the diagnosis, it is advisable to conduct a biopsy of the temporal artery wall. This procedure consists in excision of a small fragment of the artery located directly under the skin, under local anesthesia. The obtained biopsy specimen is examined for the presence of inflammatory changes, as well as multinucleated giant cells (hence the name giant cell arteritis). Almost 20% of patients with rheumatic polymyalgia have temporal artery biopsy results similar to those observed in patients with temporal arteritis. Sometimes an artery biopsy produces a false-negative result, which may be due to the presence of unchanged artery sites or initiated by steroid therapy.
The causes of temporal arteritis have not yet been elucidated. There is an assumption that this disease is associated with a pathological immune response in the walls of the arteries. It is believed that a similar mechanism underlies the development of rheumatic polymyalgia. The loss of vision in the temporal arteritis is due to thrombosis of the retina blood vessels. Transient visual impairment and pain in the jaw are associated with partial restriction of blood flow. Data that indicate the infectious nature of the disease are not available. Temporal arteritis is not a hereditary disease. However, interracial differences in morbidity indicate that a genetic predisposition can play a role in its development. With temporal arteritis positive dynamics is observed after two or three days of therapy with high doses of steroids. At the risk of vision loss, some specialists recommend starting treatment with intravenous steroids. When developing visual disorders, oral administration of prednisolone at a minimum dose of 60 mg per day is recommended. With temporal arteritis, it is important not to postpone the initiation of treatment until the biopsy results are obtained. Arterial biopsy should be performed as soon as possible. During the first week of steroid treatment, her results may remain positive.
Long-term follow-up
At the first positive results of treatment, the dose of steroids gradually decreases to the minimal maintenance level (7.5-10 mg per day). This significantly reduces the risk of side effects of steroid therapy (eg, osteoporosis or reduced resistance to infections). In some cases, immunosuppressants (eg, azathioprine or methotrexate) are prescribed in place of steroids, mainly in those patients who are severely affected by the abolition of corticosteroids. To prevent the recurrence of the disease treatment should last about two years.
To assess the effectiveness of treatment is carried out:
- periodic observation of the severity of symptoms;
- control of ESR in dynamics.
The prognosis largely depends on the timeliness of the beginning of treatment. In case of serious visual impairment, the probability of complete recovery is small. Nevertheless, against the background of treatment, partial improvement in visual function can be observed. Progression of the disease after the onset of steroid therapy is unlikely. Reducing the dose of steroids can trigger a relapse of the disease. However, the risk of relapse is reduced after one and a half years of treatment, or a year or more after its termination. Complete remission is usually achieved after two years from the start of treatment.
Morbidity
Temporal arteritis usually develops in people older than 50 years. Women are sick twice as often as men. The prevalence of temporal arteritis varies from country to country. On average, among people older than 50 years, the incidence is 0.49-23.3 cases per 100 000 population per year.