Giant Cell Arteritis/Temporal Arteritis

Abstract

Patients with giant cell arteritis are usually above the age of 50 and present with new-onset headache which is due to an idiopathic inflammatory process involving the cranial arteries. The headache is usually maximal over the temporal areas and aggravated by trivial contact during hair combing, etc. A particularly worrisome symptom is that of visual impairment since this may indicate ischemic optic neuropathy and potential permanent vision loss which occurs in 10–15 % of untreated or undertreated patients. On physical examination, the patient may have temporal artery tenderness or decreased pulsation upon palpation. Patients may describe features of tongue and jaw claudication. Since about 50 % of patients with giant cell arteritis may have polymyalgia rheumatica, there may also be complaints about shoulder and hip girdle stiffness and pain, together with constitutional symptoms like malaise, low-grade fever, night sweats, anorexia, and weight loss. An essential laboratory feature is an elevated ESR of 50 mm/h or more; CRP and fibrinogen may also be increased. The patient should have an urgent temporal artery biopsy for diagnostic confirmation; however, steroid treatment should not be delayed while waiting for the procedure. A long-term maintenance steroid regimen is usually required and immunosuppressants like cyclophosphamide may be used for steroid sparing.