giant cell arteritis
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.
|Patient age older than 50 years at disease onset||Development of symptoms or findings beginning when a patient is older than 50 years|
|New headache||New onset or new type of localized pain in the head|
|Temporal artery abnormality||Temporal artery tenderness on palpation or decreased temporal artery pulse, unrelated to arteriosclerosis of the cervical arteries|
|Elevated ESR||ESR greater than 50 mm per hour by the Westegren method|
|Abnormal biopsy||Biopsy 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.
- (1) Warrington KJ, Matteson EL. Management guidelines and outcome measures in giant cell arteritis (GCA). Clin Exp Rheumatol 2007;25(Suppl.47): s137-s141
- (2) Salvarani C, et al. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008 Jul 19;372(9634):234-45
- (3) Epperly D et al. Polymyalgia rhematic and temporal arteritis.Am Fam Physician 2000;62: 1-12.
- (4) CKS (Accessed 10/1/18). Giant Cell Arteritis.
Last reviewed 05/2021