It is important to establish the diagnosis of
temporal arteritis because the disease is treatable; treatment may prevent
blindness and even death.
Temporal arteritis usually occurs in people older than 51 years of age, although very rarely, histologically documented disease occurs in younger people. The onset may be occult, so that there are few findings. A multitude of signs and symptoms may occur such as
fever,
headaches, malaise,
weight loss,
anemia,
stroke,
cranial nerve palsies,
polymyalgia rheumatica,
aortitis and other large vessel involvement. The eye may suffer from
ischemic optic neuropathy (anterior or posterior), central or cilio-
retinal arterial occlusion, ophthalmic artery
ischemia, or extraocular muscle
palsies. An arterial biopsy showing
giant cell arteritis establishes the diagnosis. However, a negative biopsy does not rule out the disease because of the occasional presence of skip areas. Arteriography has only rarely yielded a positive temporal artery biopsy when the initial biopsy done elsewhere was negative. As a diagnostic parameter, the erythrocyte sedimentation rate is nonspecific, being elevated in diseases other than
temporal arteritis and sometimes being falsely lowered by technical factors. Furthermore, the temporal artery biopsy is occasionally positive despite a normal erythrocyte sedimentation rate. Treatment is aimed at relieving the patient's symptoms and normalizing the erythrocyte sedimentation rate. Because of the wide spectrum of clinical and laboratory finding in
temporal arteritis, no one specific treatment regimen with systemic
corticosteroids works for all patients.
Temporal arteritis is a well known disease of the elderly which ir rarely fatal but results in significant visual morbidity (Hinzpeter & Naumann, 1976; Spencer & Hoyt, 1960). Since Hutchinson's (1890) description, more than a thousand articles have been written on the subject (Cohen & Smith, 1974). Despite this, many unanswered questions and controversies remain concerning the diagnosis, prognosis and treatment of
temporal arteritis. My goal is to review these questions and areas of controversy.