giant cell arteritis

Last reviewed 05/2021

Temporal arteritis is a chronic vascular disease of unknown origin occurring in the elderly, characterized by granulomatous inflammation in the wall of medium-size and large arteries (1).

Although any large artery may be affected, it is the branches of the carotid artery that result in the majority of the symptoms and signs. The condition primarily affects the aorta and its extracranial branches (2).

There is a significant clinical overlap with polymyalgia rheumatica.

The American College of Rheumatology considers that 3 of the 5 developed diagnostic criteria must be met to support diagnosis of temporal arteritis.

Criterion Definition
Patient age older than 50 years at disease onsetDevelopment of symptoms or findings beginning when a patient is older than 50 years
New headacheNew onset or new type of localized pain in the head
Temporal artery abnormalityTemporal artery tenderness on palpation or decreased temporal artery pulse, unrelated to arteriosclerosis of the cervical arteries
Elevated ESRESR greater than 50 mm per hour by the Westegren method
Abnormal biopsyBiopsy specimen with artery showing vasculitis characterized by a pre-dominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells

Suspect giant cell arteritis if the person is aged 50 years or older with at least one of (4):

  • A new onset localized headache that is usually unilateral, in the temporal area, but is occasionally diffuse or bilateral
  • A temporal artery abnormality such as tenderness, thickening, or nodularity (present in 45–75% of people with the condition). Occasionally the overlying skin is red, and pulsation may be reduced or absent.