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Arteriitis temporalis
A new headache over fifty, with pain on chewing or a tender temple: here treatment starts before confirmation — it is about eyesight.
Also known as: temporal arteritis · Horton disease · large-vessel vasculitis
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
Giant cell arteritis is an inflammation of medium and large arteries, preferentially the branches in the head. It occurs practically only after the age of fifty, most often beyond seventy. Its importance lies not in how common it is but in its window of time: untreated it can take the sight within days, and what is once gone does not come back. It is therefore one of the few diagnoses in which treatment starts on well-founded suspicion and not after confirmation. Typical are a new headache unlike previous ones, a temple tender to touch where even combing hurts, and pain on chewing that forces a pause — this last sign is the most telling of all. Often added are fever with no recognisable infection, night sweats, weight loss and the stiffness in shoulders and hips that has a name of its own. Brief blackouts of vision in one eye are a warning shot and belong assessed the same day. Treatment with cortisone works quickly and then lasts a long time, usually one to two years at decreasing doses.
The tissue sample from the temple artery stays informative for one to two weeks after treatment begins. So it is not waited for — the order is deliberate, and it saves eyes.
Two values available everywhere and immediately. Together with the complaints they are enough to begin.
It is painless, takes minutes and shows the thickened vessel wall. In many centres it replaces the tissue sample or precedes it — asking for it is worthwhile.
Treatment lasts one to two years at slowly decreasing doses. If headache, chewing pain or stiffness return, that is a relapse and a reason to get in touch — not to put up with.
After cortisone for so long, one’s own control needs months to start up again. The rule for sick days and an emergency card belong with it.
A long course of cortisone costs bone density and lifts blood sugar. Calcium, vitamin D and a bone density measurement belong to the plan, not as an addition.
A brief darkening in one eye, double vision or a new loss of sight tolerate no delay. Between the first blackout and permanent loss there are often only days.
A threadworm can stay silent in the gut for decades and, under cortisone, biologicals or other immune suppression, flood lung and bloodstream. Anyone who ever went barefoot in the tropics or subtropics is looked for beforehand with a blood test — one effort, and it prevents the worst course this worm has.
Cortisone is started at once, before the biopsy result — here timing decides sight, because visual loss is usually not reversible. The headaches often improve within twenty-four to forty-eight hours; that in itself is a clue. The biopsy stays informative for up to two weeks after starting. Treatment lasts one to two years with slow reduction; tocilizumab helps to spare cortisone.
Almost only people over fifty are affected; the frequency rises clearly with age. The sedimentation rate is usually above fifty millimetres in the first hour, but can be normal in a small share — a normal value does not rule it out. Without treatment about one in five suffers visual loss; with timely treatment it is under two in a hundred. In about half there is a polymyalgia rheumatica at the same time.
The most telling single sign. Anyone who has to stop while eating an apple or a piece of meat because the jaw tires and hurts belongs assessed at once.
It is not the strength that counts but that it is new and different. It often sits at the temple, but it can lie anywhere in the head.
A scalp tender to touch, sometimes with a thickened, tender cord at the temple where no pulse can be felt any more.
For seconds to minutes everything goes dark on one side, then it returns. That is the warning shot before permanent loss and the most urgent occasion of all.
In older people giant cell arteritis is one of the classic causes of a fever with no infection. The head symptoms are then sometimes absent altogether.
About half also have the muscle stiffness in the shoulder and pelvic girdle. This detail is rarely volunteered but weighs in.
Usually clearly raised and the first value ordered. It is rarely normal — a normal value does not rule the matter out when the complaints fit.
Always belongs measured together with the ESR, because the two complement each other and rarely both miss at once.
Raised platelets are a quiet, often overlooked additional hint. They support the suspicion when the picture is otherwise ambiguous.
A mild anaemia belongs to the picture and is the anaemia of chronic inflammation — not iron deficiency, even though it looks like it.
Needed before and during the cortisone treatment. A longer course lifts the blood sugar, and that belongs followed from the start.
With chronic inflammatory and autoimmune pictures low levels are common — partly because the illness itself lowers the level, partly because less time is spent outdoors. Whether correcting it changes the course is being studied; for bone and muscle it is worthwhile regardless.
They give rise to messengers that tend to end inflammatory reactions rather than fuel them. Oily sea fish twice a week is the simplest route; capsules are an option but replace no treatment.
The building material itself. Better from food than from a tin: hard cheese, yoghurt, calcium-rich mineral water, almonds, broccoli and fortified plant drinks.
Needed for steering the defences and for the healing of tissue. A lack is more common with chronic diarrhoea, little meat and pulses, and under cortisone.
Activates the proteins that build calcium into bone. Green leafy vegetables and fermented foods cover it — under coumarin blood thinning the amount stays steady rather than swinging.
Here cortisone over one to two years is the rule, often at a high starting dose. This is the situation in which bone protection is not optional: vitamin D and calcium from day one, and bone density belongs measured, not estimated.
Together with vitamin D, because cortisone damps uptake in the gut and raises loss through the kidney. About 1 000 mg a day from food and supplement together is the usual frame — more brings nothing and burdens the kidney.
Under a high cortisone dose potassium falls, and the first signs are calf cramps and muscle weakness. That belongs in the laboratory work of the first weeks, because it is easily ascribed to the illness.
Effects on inflammation and triglycerides established; cardiovascular prevention is mixed. Watch quality and freshness.
The one point that counts here: on suspicion cortisone is started at once, without waiting for the biopsy result. The reason is the eye — sight that is lost does not come back.
The treatment runs over one to two years. Over that time cortisone costs bone — which is why calcium, vitamin D and bone density belong in the plan from the start, not at the first fracture.
Steroid treatment starts high and lasts long. Calcium 1000–1200 mg a day and vitamin D usually run along from day one, not only once bone thins.
The steroid treatment runs for one to two years. Vitamin D and calcium belong from day one — bone loss on steroids starts in the first months.