Clinical features

Patients typically present with new or unaccustomed headache (1).

The features of temporal arteritis can be divided up in order of presentation:

The examination should include vital signs and blood pressure in both arms to rule out aortic arch involvement. The Neurologic examination may reveal a neuropathy. Ophthalmologic examination reveals ischemic optic neuropathy in early stages of the disease and optic atrophy later in the disease course. Immediate referral is critical to ensure prompt diagnosis of reversible retinal ischemia from ophthalmic or posterior ciliary artery involvement.

• prodromal features:
  • malaise
  • anorexia and weight loss
  • fever
  • temporal headache
  • scalp tenderness e.g. when combing hair; tenderness over temporal arteries (see below)
  • jaw claudication - virtually the only condition presenting with this feature
  • transient visual obscurations
  • often, polymyalgia rheumatica
  • atypical presentations seen in some patients include dry cough, choking sensation, and upper- and lower-extremity claudication (1)
    
    
• later features include:
  • temporal arteries may be tender, dilated, inflamed, thickened, or cordlike
    • arteries may be pulsatile, especially early in the disease course
    • bruits may occur if partial occlusion
    • in severe cases, scalp skin or oral mucosal ulceration may develop
  • ischaemic optic neuropathy causing sudden loss of vision
  • less commonly, central retinal artery occlusion
  • uncommonly, III, IV or VI nerve palsies
  • arthralgia
  • intracerebral artery involvement causing:
    • hemiplegia
    • epilepsy
  • angina and myocardial infarction

Aortic arch syndrome, thoracic aorta aneurysm, and dissection may also be seen in some patients with giant cell arteritis (2).

Reference:

• (1) Unwin B, et al. Polymyalgia rheumatica and giant cell arteritis. Am Fam Physician. 2006;74(9):1547-54
• (2) Salvarani C, et al. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008 Jul 19;372(9634):234-45