This review of temporal arteritis discusses the condition’s clinical presentation, related investigations, epidemiology and treatment.
Ophthalmologists in clinical practice will potentially diagnose and treat this disorder, which is also known as giant cell arteritis, and therefore should read this important review.
The authors note that temporal arteritis is an inflammation of medium and small extracranial vessels that may result in ocular ischemia, an aoritis followed by aortic dissection and peripheral limb ischemia. It should be considered a medical emergency due to the seriousness of end organ damage.
Temporal arteritis can present as cranial arteritis, extracranial arteritis or a polymyalgia syndrome. The most common manifestations include headache, an abnormal temporal artery with temporal artery pulsation and pain, jaw claudication, scalp tenderness and constitutional symptoms, such as fever, malaise, anorexia and weight loss.
While the presentation may be nonspecific, the presence of a tender temporal artery mandates a temporal artery biopsy, the gold standard test.
They note that the most feared complication is related to an arteritic anterior ischemic optic neuropathy, which can result in permanent visual loss. Jaw claudication, diplopia and temporal artery abnormalities may predict ischemic neuro-ophthalmic complications.
The authors stress that high-dose steroids should be started the moment the diagnosis of temporal arteritis is considered and only withdrawn once it has been excluded. A gradual tapering of the steroid dose should occur over at least one year, with consideration of the use of steroid-sparing agents if iatrogenic steroid complications occur. They say that careful monitoring of the response both clinically, as well as with serial inflammatory markers, is required.