temporal arteritis

Question 1

what is temporal arteritis

Answer 1

• also called giant cell arteritis, is a systemic inflammatory vasculitis of medium and large sized arteries occurring most frequently in adults
• particularly occurring at those around the temples

Question 2

what is the epidemiology of Temporal arteritis

Answer 2

• most common vasculitis affecting adults in western countries
• 20/100,000 people older than 50
• the mean age being 75
• and 1:2 male:female

Question 3

what is the pathophysiology/cause of temporal arteritis

Answer 3

• the exact cause is unknown
• inflamation of the medium-larged sized arteries originating from the arch of the aorta is the hallmark of the disease
• it is characterized by innate and adaptive immune system dysregulation. and the pathphysiology is thought to involve the body’s inappropriate response to vascular endothelial injury.

after the endothelium is injured, results in activation of the dendritic cells. The activated dendritic cells release chemokines attracting CD4+ helper T cells and macrophages into the arterial wall. The activated dendritic cells also release IL-6 and IL-18, which activate the T-cells and promote IFN-gamma release from the T-cells. This promotes inflammation, macrophage activation, and granuloma formation. Causing endothelial damage and disruption of the internal elastic lamina.
- when the temporal arteries become inflamed they are also constricted which can lead to serious health problems

Question 4

what is the clinical presentation of temporal arteritis

Answer 4

• although non-specific all patients have one or more constitutional symptoms (weight loss, fever, fatigue, anorexia, malaise)
• new onset headaches or a change in the baseline headache
• jaw claudication or pain and discomfort while eating due to decreased blood flow to jaw muscles is a specific symptoms of GCA
• temporal artery abnoramlity; enlargement, tenderness, nodular swelling, loss of pulse
• can also have visual symptoms, most commonly due to ischemic optic neuropathy caused by vasculitis
• TIS or strokes, can be seen

Question 5

how is Temporal arteritis diagnosed and treated/managed

Answer 5

• increased ESR and CRP
• histopathological confirmation
• Biopsy
• imaging

treatment/ managment
- corticosteriods, can prevent blindness and supress disease activity.
usually for 2-4 weeks
- low doses of aspirin