Definition and cause
The two diseases arteritis temporalis (AT) and polymyalgia rheumatica (PR) are so closely related that they are described in a single article. About half of patients with AT also have PR, and 10-15% of patients with polymyalgia rheumatica have changes similar to arteritis temporalis.
Arteritis means inflammation of an artery, and since the disease most commonly occurs in the temporal artery, it has been given its name. The disease can also be seen in other head arteries including the eye arteries.
The disease is also known as giant cell arteritis due to the typical appearance of the inflammatory cells.
When inflammation occurs in an artery, the artery may be occluded and cause problems from the area which it serves with oxygen.
Both AT and PR are virtually never seen in patients under 50 years, and often the disease hits patients 70 years of age. Approximately 20/100.000 people over 50 years develops AT annually, and around 40/100.000 people are diagnosed annually with PR. Both diseases occur around twice as frequently in women.
Symptoms of arteritis temporalis and polymyalgia rheumatica
Common symptoms of the two diseases are:
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Fatigue.
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Fever.
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Decreased appetite.
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Weight loss.
By polymyalgia rheumatica additional symptoms are seen:
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Muscle stiffness.
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Muscle pain.
The symptoms are predominantly in the shoulder region, in the neck muscles, and in the muscles of the pelvis. By arteritis temporalis other symptoms in addition to the common symptoms may be seen:
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Temporal headache, often located to only one side, but can also be seen in both temples.
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Sore muscles when chewing.
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Soreness, redness and lack of pulse in the temporal artery.
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If the eye artery is involved, there is vision impairment that eventually may lead to blindness. Eye manifestations are therefore very severe symptoms that require emergency treatment.
Precautions and diagnosis
If prolonged headaches are experienced always consult a doctor. Are you over 50 years and feel a general malaise and headache, combined with muscle pain and stiffness, a doctor may choose to examine the temporal arterity.
Apart from the classic disease picture a blood test that can reveal whether there is an inflammation in the body may be conducted.
The final confirmation of the diagnosis is done in a microscope where the presence of giant cells in a tissue (biopsy) from the temporal artery.
Consideration of the arteritis temporalis and polymyalgia rheumatica
Treatment consists in the acute cases (especially if there is eye involvement) of high doses of prednisolone (adrenal cortical hormones). The treatment is very effective, and even within the first 24 hours an improvement may be seen.
Patients with polymyalgia rheumatica are not treated as acute, and with smaller doses of prednisolone. Treatment is slowly reduced down to the lowest possible dose. The disease activity is assessed by blood tests on an ongoing basis.
Prognosis
Quite frequently the disease breaks out again. Often 1-3 years after initial onset and often in conjunction with sessation of medication. At renewed disease the dose of Prednisolone will be reincreased or reinstated.
The vast majority of patients with these diseases are however completely recovered after treatment.
Complications
The most frequent serious complication of arteritis temporalis is blindness. At the slightest sign of eye involvement, treatment must be instituted quickly, and before vision impairment or blindness occurs as this will lead to irreversible damage.
When the arteries to the brain are occluded strokes can be seen .
There are no dangerous complications of polymyalgia rheumatica in addition to the increased risk of developing arteritis temporalis.
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