Temporal Arteritis treatment and symptom
January 12 2018 by
Ray Sahelian, M.D.

Temporal arteritis, also known as giant cell arteritis, is an inflammatory condition affecting the medium-sized blood vessels that supply the head, eyes, and optic nerves. The disease usually affects adults over 60 years of age and causes the vessels in the temple and scalp to become swollen and tender. Women are approximately several times more likely to suffer from this disease then men.
   Temporal arteritis is inflammation and damage to blood vessels that supply the head area, particularly the large or medium arteries that branch from the neck. If the inflammation affects the arteries in the neck, upper body and arms, it is called giant cell arteritis.

Temporal arteritis treatment
Quick and effective treatment of patients with temporal arteritis is crucial in order to avoid vision loss. The initial prednisone dosage should be between 50 to 80 mg a day. Some doctors decrease the prednisone dosage by 10 percent each week based on symptoms, side effects and results of the ESR. In most cases steroid therapy is stopped within one year.

Ther Adv Chronic Dis. 2017. Update on the management of giant cell arteritis. Given the serious side effects associated with prolonged courses of glucocorticoids and frequent relapses experienced when doses are tapered, increased efforts are being dedicated to the discovery of safer and more effective therapies. The purpose of this review is to critically evaluate the role of glucocorticoid-sparing agents in the medical management of GCA with a special focus egarding the role of biologic agents, including tocilizumab (TCZ), abatacept and ustekinumab, and other novel therapies.

Temporal arteritis symptoms
Patients with temporal arteritis have symptoms usually in one eye, but within a few days the other eye may be affected. Common temporal arteritis symptoms include severe pain in temple area, headache, blurred vision, fatigue, low mood, tenderness of the scalp, a decrease in appetite, and elevated body temperature.

Giant-cell arteritis is a systemic autoimmune disease affecting primarily the elderly. Giant cell arteritis can cause sudden and potentially bilateral sequential vision loss in the elderly. Therefore, it is considered a medical emergency in ophthalmology and a significant cause of morbidity in an increasingly aging population.

Diagnosis
Temporal arteritis, also called giant cell or cranial arteritis, is a systemic inflammatory vasculitis of medium and large-sized arteries. This results in ischemic optic neuropathy with irreversible or significant visual loss on the affected side with possible contralateral involvement. Left untreated, it can result in many systemic, neurologic, and ophthalmologic complications. Although the temporal artery is most commonly involved, other arteries may certainly be affected. These include the aorta and the subclavian, iliac, ophthalmic, occipital, and vertebral arteries. Although not necessary, the disease is commonly associated with polymyalgia rheumatica.

Ned Tijdschr Geneeskd. 2015. Temporal arteritis: do not rely on the erythrocyte sedimentation rate. Three patients with signs of temporal arteritis are presented. In two patients a normal ESR resulted in the diagnosis 'temporal arteritis' being discarded, prompting clinicians to consider meningitis, sinusitis, and blindness due to atherosclerosis. In the third case, the ESR measured with the Alifax Test-1TH apparatus was 17 mm/h, whereas the Westergren method used on the same sample resulted in an ESR of 83 mm/h. In all three cases CRP was elevated. On the basis of literature on the sensitivity of ESR and CRP it is advisable to use both measures when temporal arteritis is being considered. It is noted that in one hospital using the Alifax Test-1TH, only 52% of 25 patients with biopsy-proven temporal arteritis had an ESR over 40 mm/h, while 96% had elevated CRP.

Cause of Temporal arteritis
The cause of temporal arteritis is unknown but is assumed to be, at least in part, an effect of the immune response. Is the estrogen level drop after menopause one of the reason the inflammation occurs after age 50 in women? For more information on inflammation. Would dietary changes that lead to less inflammation help this condition?

Int J Rheum Dis. January 17 2014. Giant cell arteritis with visual loss following zoledronic acid infusion. Zoledronic acid is used in the treatment of osteoporosis. Giant cell artertitis may lead to vision loss. We report a case in which vision loss occurred after zoledronic acid infusion.

Testimonial
I was recently diagnosed with this condition, after many weeks of high stress. It was confirmed positive by biopsy by Mayo Clinic. CRP was high at 5.9, SED rate 56. (These tests were normal last year). The condition and worry itself is now causing anxiety attacks. There was no eye involvement. I was started on 60 mg of Prednisone a day. I went in 6 days later for the biopsy. This may be a long term treatment. I hope the underlying auto immune dysfunction crashes and burns sooner rather than later, but in the meantime, I have to take the Pred. What can I do to counteract the horrible side effects of this evil miracle drug? I am a 73 year old woman. I also have normal pressure Glaucoma which Pred can exacerbate. I am worried about my bones since this will be an ongoing treatment. I donít want to give up active lifestyle. I live in northern Minnesota and no sun in the winter.
   A. I am not aware of a specific supplement that can counteract the potent effects of steroids. Hopefully your dose will be lowered over time. Just maintaining the best you can do with diet and healthy lifestyle choices is the best option that I know of at this time.