Arteritis temporalis is an inflammatory disease that primarily affects older people. Early therapy usually leads to rapid symptom relief.
What is arteritis temporalis?
Arteritis temporalis is an inflammatory autoimmune disease (a condition in which the body’s immune system mistakenly targets the body’s own tissues) that primarily affects the temporal arteries (arteriae temporales). Alternative terms for temporal arteritis include Horton’s disease or giant cell arteritis. Arteritis temporalis almost exclusively affects individuals over the age of 50. Women are about three times more likely to be affected by temporal arteritis than men. The initial symptoms of temporal arteritis in many patients include a severe, stabbing headache. In most cases, this headache intensifies during chewing. In a smaller percentage of patients, a sudden visual loss in one eye occurs in the presence of temporal arteritis. Occasionally, the autoimmune disease may also present with symptoms such as paralysis of the eye muscles, as well as fever, muscle pain, and fatigue.
Causes
The causes of incident temporal arteritis have not been conclusively determined in the medical community. A genetic component of arteritis temporalis is assumed – for example, if the disease occurred in parents and/or grandparents, there is an increased risk of contracting arteritis temporalis oneself. Furthermore, a possible influence of infectious diseases on the occurrence of arteritis temporalis is discussed: Possibly, different viruses and bacteria are able to provoke the development of arteritis temporalis. The relevant viruses include, above all, influenza or flu viruses and the hepatitis B virus. Bacteria that may potentially promote the occurrence of temporal arteritis primarily include the so-called Borrelia – a helical type of bacteria.
Symptoms, complaints, and signs
As a rule, the complaints and symptoms of arteritis temporalis are relatively clear and point directly to the disease. For this reason, the disease can also be diagnosed and treated relatively early. Those affected suffer first and foremost from a severe headache. This occurs mainly in the area of the temples and has a very negative effect on the quality of life of the affected person. Headaches can also occur when chewing or speaking. Furthermore, temporal arteritis leads to severe visual disturbances, so that the affected person suffers from veil vision or double vision. In general, vision also decreases as a result. Those affected also suffer from permanent fatigue and exhaustion, which usually cannot be compensated by sleep. During the night, sweating is common, and patients also suffer from severe weight loss due to temporal arteritis. The symptoms do not always have to occur all together, so that in case of a prolonged occurrence of some complaints a doctor should be consulted in any case. The headache may also spread to the ears or eyes in arteritis temporalis.
Diagnosis and course
Arteritis temporalis can be diagnosed, for example, on the basis of the so-called ACR (American College of Rheumatology) criteria. Among other things, these criteria describe typical symptoms of the autoimmune disease. If a certain number of criteria are fulfilled in an affected person, it can be assumed (with initially limited certainty) that temporal arteritis is present. The diagnosis can be confirmed, for example, by taking tissue samples from the temporal artery, ophthalmological examinations or blood tests. Ultrasound scans can also provide further diagnostic evidence of temporal arteritis. With proper therapy, the symptoms of temporal arteritis often subside completely within about 6-24 months. However, medicine does not speak of a cure in the narrower sense, because in some cases the occurrence of disease relapses is possible. In individual cases, arteritis temporalis can take a chronic (longer-term) course.
Complications
If the branches of the carotid artery are affected by arteritis temporalis, medical countermeasures must be initiated. Also known as Horton’s disease, the diagnosis triggers numerous complications, especially when the temporal artery is affected. If the affected patient receives insufficient or no medical attention, the optic nerve will be permanently damaged. There is a risk of blindness and stroke. As soon as the inflamed aorta narrows, important nerves and supply areas are no longer supplied with blood. Fatigue, stabbing headaches, aneurysms, eye muscle weakness, visual disturbances and fever episodes can cause permanent symptoms if the disease is not recognized in time. The special risk group for temporal arteritis includes people in middle age and older, the majority of whom are women. The disease itself causes various complications, as does the medication. Not all patients tolerate the oral corticosteroids that combat the symptom. These must be taken for a period of one to two years. Consistent medical monitoring is followed. Corticosteroids can negatively affect metabolic functions as well as bone structure. As a consequence, the immune system may be weakened, glaucoma or cataracts and osteoporosis may break out, and blood sugar levels or weight may increase. In turn, treatment with cortisone is stressful for the body but very successful in reducing the risk of heart attack and prevent blindness.
When should you see a doctor?
Unfortunately, the symptoms of arteritis temporalis are not particularly characteristic, so that the symptoms can also be confused with another disease. For this reason, sufferers should always consult a doctor if the symptoms occur together and for no particular reason. Especially in case of permanent headache and unexplained loss of weight, the patient must definitely consult a doctor. The pain may occur in the region of the temples and, in most cases, it is not aggravated by talking or chewing. Likewise, advice should be sought if there are sudden visual disturbances due to temporal arteritis or if the already existing visual complaints are further aggravated. Likewise, most sufferers also suffer from permanent fatigue and lassitude due to temporal arteritis. As a rule, the fatigue cannot be compensated by sleep. Early treatment can alleviate the symptoms in most cases, and the risk of stroke is also significantly reduced with treatment. In the first instance, the diagnosis is usually made by a general practitioner. Further symptoms are eventually treated by a specialist, and a visit to an ophthalmologist is usually necessary as well.
Treatment and therapy
Acute temporal arteritis is usually considered a medical emergency. If arteritis temporalis is suspected, physicians usually administer high doses of cortisone to combat inflammatory processes. One of the purposes of this treatment step, which is carried out as quickly as possible, is to prevent the inflammation from spreading to vessels in the brain and thus to reduce the risk of a possible stroke. The individually administered dose of cortisone in the case of temporal arteritis is based, for example, on guidelines issued by the German Society of Neurology; according to these guidelines, a comparatively high dose is advisable if the patient is at risk of blindness due to temporal arteritis. A comparatively lower dose of cortisone is recommended for acute unilateral blindness, while the lowest recommendation is for patients in whom the eye is not affected by symptoms of arteriitis temporalis. Such acute cortisone therapy is usually followed by continued lower-dose cortisone treatment over several months or years.
Outlook and Prognosis
Arteritis temporalis has a good prognosis in healthy individuals with a stable immune system. Once the condition is diagnosed and treated, relief of symptoms occurs within a few days. Once the inflammation has healed, the patient may also be discharged from treatment as symptom-free.However, in most cases the healing process takes several months or years. On average, it takes 6-24 months for the consequences of temporal arteritis to heal and for the body’s defense system to become stable. The disease occurs more frequently in people at an older age. This increases the probability of the presence of other diseases. In these cases, the immune system is additionally weakened and the organism has hardly any possibilities to successfully oppose the inflammatory process of temporal arteritis. As a result, a delay in healing occurs, which also affects the already existing diseases. In acute temporal arteritis, the patient is at risk of sudden death. The progress of the inflammation cannot be stopped, hemorrhage occurs, and the patient dies of heart failure or stroke. People who do not seek medical care also live with a greatly increased risk of death. Blindness or functional impairment may occur.
Prevention
Because temporal arteritis is thought to be genetically favored, prevention of the disease is limited. If the assumption that viral and/or bacterial infections may favor arteritis temporalis is taken into account, strengthening the body’s immune system may help to reduce the risk of an occurring autoimmune disease.
Follow-up
Follow-up care aims to prevent recurrence of temporal arteritis through scheduled examinations. Given the positive prognosis, no further symptoms are expected after a medically supervised cure. In older people, the regeneration process is sometimes delayed. Immunity does not build up. Rarely, a chronic form of the disease develops. The cause of temporal arteritis has not been conclusively clarified. Some scientists assume that genetic factors are the trigger. These cannot be influenced. However, it is recognized that strengthening the immune system prevents recurrence of the disease. This is the responsibility of the patient and can be medically verified by blood tests, for example. Patients should ensure that they eat a diet rich in vitamins and fiber. Regular exercise is important. Harmful substances such as nicotine and alcohol should be avoided. Once ill, sufferers should make sure they get enough sleep and rest. Stress at work and in everyday life should be avoided as far as possible. Arteritis temporalis is diagnosed using the criteria of the American College of Rheumatology. Blood tests and Doppler ultrasonography play a particularly important role. These can be repeated at regular intervals to prevent recurrence of complications. The decisive factor is the prevention of permanent formation.
What you can do yourself
Because arteritis temporalis can easily be confused with other diseases due to its symptomatology, it is often difficult for a layperson to recognize in everyday life. This severely limits the measures and options for self-help. Since it is an autoimmune disease, the affected person can basically pay attention to strengthening his immune system even without the suspicion of this diagnosis. With a healthy lifestyle, he strengthens his defenses and thus stabilizes his organism. At the same time, the healing process of diseases is shortened if a strong immune system is present. For this, a vitamin-rich and balanced diet is important. The body needs sufficient nutrients, trace elements and regular exercise. This stimulates the metabolism and prevents fat accumulation. The body weight should be within the normal weight. At the same time, the body should be supplied with a sufficient amount of fluids every day. Harmful substances such as nicotine or alcohol should be avoided. Sufficient sleep, regular rest and recovery phases are also important to strengthen the organism. In stressful situations or phases of life, relaxation techniques or communication within a good social environment help to restore inner balance. As soon as the affected person feels an unexplainable malaise, he should consult a doctor and ask for further examinations.
