Most specific symptom of temporal arteritis

temporal arteritis

    Having headaches is considered quite common when it occurs occasionally. Almost everyone will have a headache at some point of their life and mostly triggered by daily lifestyle or stress. Although it seems harmless to have headaches at times, having it frequently as if almost everyday is not considered normal and may raise concerns of serious conditions.  In this article, we will be talking more of a serious disease called “temporal arteritis” causing much more damage than just an average headache.

    Temporal arteritis or giant cell arteritis is defined as an inflammation of the medium to large-sized blood vessels, particularly the arteries which usually happens in adults especially to those aged 50 years and above. In most cases, it is marked by the inflamed arteries of the temple (side of the head). Smokers and those with family members diagnosed with giant cell arteritis have a higher risk of developing this disease.  The exact cause is not clearly known, but it has been proposed by the maladaptive immune body response affecting the blood vessels to become seriously inflamed or due to infections by Chlamydia, Mycoplasma, varicella virus or parainfluenza virus.  

    People with temporal arteritis need to have urgent treatment as any delay can cause significant problems to the eyesight and possible loss of vision. Hence, it is important to spot the symptom early on. Such symptoms are:

1. Jaw claudication.

This is considered as the most specific symptoms, yet always unreported to healthcare personnel. It refers to pain or discomfort in the jaw, most noticeable during chewing, particularly when having tough foods such as meat or chewing gums. The claudication happens as a result of decreased blood flow to the jaw muscle. The painful sensation typically relieved after the chewing stopped. Sometimes prolonged speaking can exacerbate the jaw discomfort. Since this symptom might also be caused by other health conditions, it needs to be differentiated by some physical examination. In temporal arteritis, the temporal arteries over the temples may feel tender upon touch and in a cordlike shape. This can happen to one or both sides of the head.

2. Headache

Frequent and severe headache especially at the temple. It can also be around the eyes area, bottom back of the head or even any part of the head. The headache can be either resolved spontaneously without treatment or not responding to any over-the-counter (OTC) analgesic.  

3. Scalp tenderness

Pain sensation or discomfort of the scalp can be an initial sign of an impending temporal arteritis. The pain can be easily recognized while brushing hair or placing your head on a pillow. Scalp necrosis or death of scalp tissue in the form of redness, ulcerated or bald area, can be seen in some severe cases. 

4. Vision problems

The inflamed blood vessel in this giant cell arteritis causes reduced blood supply to the optic nerve (responsible for eyesight). A person may have double vision or loss of vision in one or both eyes. Vision loss can be partial or complete, usually sudden and painless. The damages are irreversible. Thus, early treatment is important to curb further vision loss.  

5. Polymyalgia rheumatica

An inflammation affecting muscle around shoulder, neck and hip, causing pain and stiffness. Temporal arteritis and polymyalgia rheumatica share the same course of disease, which is inflammation of arteries. 

6. Non-specific symptoms

Example: flu-like symptoms, weight loss, fatigue, fever and loss of appetite is common.

    Further investigation by doctors usually involves blood test especially erythrocyte sedimentation rate (ESR) and temporal artery biopsy. Early treatment such as steroid medicine is essential to treat this disease, especially to prevent permanent vision loss.

References:

https://www.nhs.uk/conditions/temporal-arteritis/

https://www.ncbi.nlm.nih.gov/books/NBK459376/

https://eyewiki.aao.org/Giant_Cell_Arteritis

By aamritri

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