Temporal arteritis
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222253828
2008-06-28T10:20:08Z
VolkovBot
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robot Adding: [[pl:Olbrzymiokomórkowe zapalenie tętnic]]
{{Infobox_Disease |
Name = Temporal arteritis |
Image = Gray508.png |
Caption = The arteries of the face and scalp. |
DiseasesDB = 12938 |
ICD10 = {{ICD10|M|31|5|m|30}} |
ICD9 = {{ICD9|446.5}} |
ICDO = |
OMIM = 187360 |
MedlinePlus = |
eMedicineSubj = neuro |
eMedicineTopic = 592|
MeshID = D013700 |
}}
'''Temporal arteritis''', also called '''giant cell arteritis''' ('''GCA''') is an [[inflammation|inflammatory]] disease of [[blood vessel]]s (most commonly large and medium [[artery|arteries]] of the head). It is therefore a form of [[vasculitis]]. The name comes from the most frequently involved vessel ([[temporal artery]] which branches from the [[external carotid artery]] of the neck). The alternative name (giant cell arteritis) reflects the type of inflammatory cell that is involved (as seen on [[biopsy]]).
The disorder may coexist (in one quarter of cases) with [[polymyalgia rheumatica]] (PMR), which is characterized by sudden onset of pain and stiffness in muscles ([[pelvis]], [[shoulder]]) of the body and seen in the elderly. Other diseases related with temporal arteritis are systemic [[lupus erythematosus]], [[rheumatoid arthritis]] and severe [[infection]]s.
==Symptoms==
It is more common in females than males by a ratio of 3:1. The mean age of onset is about 70 years and is rare at less than 50 years of age.
Patients present with:
* [[fever]]
* [[headache]]
* tenderness and sensitivity on the [[scalp]]
* [[jaw]] [[claudication]] (pain in jaw when chewing)
* reduced [[visual acuity]] (blurred vision)
* acute [[visual loss]] (sudden blindness)
The inflammation may affect blood supply to the [[eye]] and blurred vision or sudden [[blindness]] may occur. In 76% of cases involving the eye, the [[ophthalmic artery]] is involved causing [[anterior ischemic optic neuropathy]].<ref>{{cite web |author=Hayreh |title=Ocular Manifestations of GCA |url=http://webeye.ophth.uiowa.edu/dept/GCA/04-ocular.htm |date=April 3, 2003 |publisher University of Iowa Health Care |accessdate=2007-10-15}}</ref> Loss of vision in both eyes may occur very abruptly and this disease is therefore a [[medical emergency]].
==Diagnosis==
===Physical exam===
Palpation of the head reveals sensitive and thick arteries with or without pulsation.
===Laboratory tests===
[[Erythrocyte sedimentation rate|Sedimentation rate]] is very high in most of the patients, but may be normal in approximately 20% of cases.
===Biopsy===
The [[Gold standard (test)|gold standard]] for diagnosing temporal arteritis is [[biopsy]], which involves removing a small part of the vessel and examining it [[microscope|microscopically]] for [[giant cell]]s infiltrating the tissue. Since the [[blood vessel]]s are involved in a patchy pattern, there may be unaffected areas on the vessel and the biopsy might have been taken from these parts. So, a [[false negative|negative result]] does not definitely rule out the diagnosis.
===Radiology===
Radiological examination of the temporal artery with [[ultrasound]] yields a [[halo sign]].
Contrast enhanced brain MRI and CT is generally negative in this disorder.
==Treatment==
[[Corticosteroid]]s must be started as soon as the diagnosis is suspected (even before the diagnosis is confirmed by biopsy). Steroids do not prevent the diagnosis later being confirmed by biopsy, although certain changes in the histology may be observed towards the end of the first week of treatment and are more difficult to identify after a couple of months.<ref name="pmid16987903">{{cite journal |author=Font RL, Prabhakaran VC |title=Histological parameters helpful in recognising steroid-treated temporal arteritis: an analysis of 35 cases |journal=The British journal of ophthalmology |volume=91 |issue=2 |pages=204–9 |year=2007 |pmid=16987903 |doi=10.1136/bjo.2006.101725}}</ref>
==References==
{{refbegin}}
*[http://webeye.ophth.uiowa.edu/dept/GCA/index.htm U of Iowa Prof. Sohan Singh Hayreh's Giant Cell Arteritis article]
*[http://www.niams.nih.gov/hi/topics/polymyalgia/ Polymyalgia rheumatica article from National Institute of Arthritis and Musculoskeletal and Skin Diseases]
{{refend}}
==Footnotes==
{{reflist|2}}
{{Diseases of the musculoskeletal system and connective tissue}}
[[Category:Rheumatology]]
[[Category:Ophthalmology]]
[[Category:Neurology]]
[[Category:Medical emergencies]]
[[de:Arteriitis cranialis]]
[[es:Arteritis de células gigantes]]
[[fr:Maladie de Horton]]
[[ja:側頭動脈炎]]
[[pl:Olbrzymiokomórkowe zapalenie tętnic]]
[[tr:Dev hücreli arterit]]