Temporal Arteritis

Temporal arteritis is a granulomatous arterial inflammation that characteristically involves the temporal and ophthalmic arteries, but may be part of a more widespread involvement of medium and large vessels. The patient usually presents with headache, constitutional symptoms (fever, malaise, anorexia, weight loss and anemia), and rheumatic complaints (polymyalgia rheumatica). The diagnosis should be considered in any patient over 55 years of age who develops these constitutional symptoms, or has recent onset of headache, sudden visual loss or localized arterial involvement. The diagnosis is supported by a sedimentation rate over 50 and confirmed by a biopsy of the temporal artery. Visual loss may occur in 50% of untreated patients; other serious complications are less common. Because of seriousness of long-term steroids in the elderly, it is mandatory to carry out a biopsy in all cases even if the urgency of the situation requires initiation of therapy first. Although a self-limited disease, treatment with steroids is imperative to prevent blindness and it must be maintained for a prolonged period.