Q: Can you give me some information on temporal arteritis?
-- S.R., Cape Cod, Mass.
A: Temporal arteritis is one form of vasiculitis, or inflammation of blood vessels ("-itis" always means inflammation). Temporal arteritis is a chronic inflammation of large arteries, primarily in the head.
This condition is called temporal arteritis because it's known to affect the temporal arteries, the ones at the temples. However, this disorder can be systemic, that is, it can affect other medium- to large-sized arteries, especially other branches of the carotid artery that branches off the aorta in the neck.
Classic symptoms often include severe headaches, scalp tenderness, visual problems, throat pain and difficulty chewing and talking, all depending on which arteries in the head are affected. It also mimics infection by causing high fever, but the white cell count is usually normal.
Most of the pain is thought to be due to swelling in and around the affected artery. This swelling in turn puts pressure on the nerves that run through that area.
Diagnosis is based on symptoms and examination, including blood tests for anemia and erythrocyte (red cell) sedimentation rate, and may be confirmed by an examination of a biopsy of a piece of temporal artery tissue.
Although the biopsy is a very useful tool in confirming the diagnosis of temporal arteritis, about 20 percent of the time the biopsy results will be falsely negative. If all of the other evidence fits and no other disease seems likely, staying with this diagnosis seems prudent.
The major problem with temporal arteritis is that it can quickly cause blindness that is usually permanent. The blindness is the result of the arteritis occluding the branch of the ophthalmic artery that supplies the optic nerve -- the main nerve of the eye.
That's why when symptoms suggest temporal arteritis, prednisone at 60 mg per day should be started immediately. The prednisone should probably be continued at least for a month or so, before tapering off as the activity of the disease ceases. The blood sedimentation rate, usually very high in this disease, is often used to track the effect of drug treatment.
However, the temporal arteritis may come back and remain active for years, requiring the long-term continuation of lower doses of the prednisone.
Another possible complication of temporal arteritis is the development and rupture of an aneurysm -- a bubble forming in a weakened area of a blood vessel wall -- in the part of the aorta (the main artery coming from the heart) located in the chest.
If you or someone you know has been diagnosed with temporal arteritis, stay in close contact with your doctor about symptoms caused both by the disease and the treatment.
Dr. Allen Douma welcomes questions from readers. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.