Temporal arteritis: Difference between revisions

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{{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    = |
  MeshID        = D013700 |
}}
{{Temporal arteritis}}
{{Temporal arteritis}}


{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}
'''For patient information, click [[Temporal arteritis (patient information)|here]]'''


{{SK}} GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; granulomatous arteritis; polymyalgia arteritica
{{CMG}}; {{AE}} {{HQ}}


==Overview==
{{SK}} GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; Horton-Magath-Brown syndrome granulomatous arteritis; polymyalgia arteritica
'''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.
==[[Temporal arteritis overview|Overview]]==


This diagnosis should be considered in any patient over the age of 50 with the new onset of [[headache]], particularly is the [[erythrocyte sedimentation rate]] is elevated.
==[[Temporal arteritis historical perspective|Historical Perspective]]==


Prompt treatment with steroids is a medical emergency to reduce the risk of [[blindness]].
==[[Temporal arteritis classification|Classification]]==


==Pathophysiology==
==[[Temporal arteritis pathophysiology|Pathophysiology]]==


The damage to the vasuclature is mediated by an attack on the internal elastica lamina by activated CD4+ [[T helper cell]]s.  This occurs in repsonse to the presentation of an [[antigen]] by [[macrophages]]. The inciting antigen has not been identified.
==[[Temporal arteritis causes|Causes]]==


Because the disease involves only arteries with internal elastic lamina, the aortic arch and its branches are often involved. Intracranial arteries do not have internal elastic lamina and are not involved. The distribution of involved arteries are as follows:
==[[Temporal arteritis differential diagnosis|Differentiating Temporal Arteritis from other Diseases]]==


==='''''Commonly involved sites:'''''===
==[[Temporal arteritis epidemiology and demographics|Epidemiology and Demographics]]==


'''Cervicocephalic arteries''': [[carotid artery]] and [[vertebral artery]].  The [[vertebral artery]] is involved as frequently as the temporal artery in fatal cases. Involvement of the [[basilar artery]] is rare.
==[[Temporal arteritis risk factors|Risk Factors]]==


'''Intraorbital branches''': Posterior ciliary artery and [[ophthalmic artery]].
==[[Temporal arteritis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
'''External common, external, and internal carotid artery involvement:''' It is less common for proximal intracranial arteries to be involved.
 
'''External vertebral arteritis:''' It is less common though for the disease to extend more than 5 mm beyond the dural penetration.
 
'''Subclavian, axially and proximal brachial artery:''' There can be typical vasculitic lesions with long, smooth, lesions with tapered occlusions.
 
'''Coronary arteries''': for a full discussion of the involvement of the heart in this disorder see the chapter on [[The Heart in Temporal Arteritis / Giant Cell Arteritis]]
 
==='''''Less commonly involved sites:'''''===
 
'''Descending aorta:''' Mesenteric, iliac, femoral and renal arteries are less often involved. In these cases there can be [[mesenteric ischemia]], [[renal infarction]], and ischemic [[mononeuropathy]] can occur.
 
'''Pulmonary artery'''
 
==Diganosis==


==Diagnosis==
==Diagnosis==
===Laboratory tests===
[[Temporal arteritis diagnostic study of choice|Diagnostic Study of Choice]] | [[Temporal arteritis history and symptoms|History and Symptoms]] | [[Temporal arteritis physical examination|Physical Examination]] | [[Temporal arteritis laboratory findings|Laboratory Findings]]  | [[Temporal arteritis CT|CT]] | [[Temporal arteritis MRI|MRI]] | [[Temporal arteritis echocardiography or ultrasound|Ultrasound]] | [[Temporal arteritis other imaging findings|Other Imaging Findings]] | [[Temporal arteritis other diagnostic studies|Other Diagnostic Studies]]
[[Erythrocyte sedimentation rate|Sedimentation rate]] is very high in most of the patients, but may be normal in approximately 20% of cases.
 
===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==
==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>
[[Temporal arteritis medical therapy|Medical Therapy]] | [[Temporal arteritis surgery|Surgery]] | [[Temporal arteritis primary prevention|Primary Prevention]] | [[Temporal arteritis secondary prevention|Secondary Prevention]] | [[Temporal arteritis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Temporal arteritis future or investigational therapies|Future or Investigational Therapies]]
 
A 3 day course of pulse steroids with 250 mg of IV [[solumedrol]] BID is critical in reducing the risk of permanent [[visual loss]]. If there is progression of visual loss on steroids, IV [[heparin]] can be administered to reduce the risk of thrombotic occlusion.
 
Treatment should not be deferred while waiting on the results of a [[temporal artery]] biopsy.
 
==References==
{{reflist|2}}


==Additional Resources==
==Case Studies==
*[http://www.niams.nih.gov/hi/topics/polymyalgia/ Polymyalgia Rheumatica]
[[Temporal arteritis case study one|Case #1]]


{{Diseases of the musculoskeletal system and connective tissue}}
{{Diseases of the musculoskeletal system and connective tissue}}
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[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]





Latest revision as of 19:07, 16 April 2018

Temporal Arteritis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Temporal Arteritis from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

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Laboratory Findings

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CT

MRI

Other Imaging Findings

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Treatment

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Case #1

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For patient information, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]

Synonyms and keywords: GCA; giant cell arteritis; cranial arteritis; Horton's disease; Horton disease; Horton's arteritis; Horton syndrome; Horton's syndrome; Horton-Magath-Brown syndrome granulomatous arteritis; polymyalgia arteritica

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Temporal Arteritis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice | History and Symptoms | Physical Examination | Laboratory Findings | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

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