Q. A doctor told my cousin that she had arthritis in her head. I never heard of such a thing. Have you?
I’ve never heard of head arthritis, but I don’t think that’s what the doctor said to your cousin. I’m pretty sure the doctor was talking about temporal arteritis, which is also known as cranial arteritis and giant cell arteritis.
Arthritis is inflammation of a joint. Arteritis is inflammation of an artery. Temporal arteritis (TA) affects the blood vessels that supply the head, particularly the arteries that branch off from a blood vessel in the neck called the carotid artery.
TA rarely occurs in patients younger than 50. Women develop TA two to three times more frequently than men. The incidence of the condition increases with age. TA occurs more frequently in white patients, especially those with northern European backgrounds.
The cause of TA is not known.
Most people make a full recovery from TA, but treatment for a year or two may be needed. The condition can return after a recovery.
Corticosteroids may be prescribed to reduce inflammation. Medications that suppress the immune system are occasionally prescribed. Aspirin may also be recommended. Patients usually start feeling better within days of starting treatment.
Corticosteroids are powerful anti-inflammatory drugs that can lead to some serious side effects. Older adults are particularly at risk because they're more prone to certain conditions that may be caused by corticosteroids. These include: osteoporosis, high blood pressure, muscle weakness, cataracts, thinning skin and increased bruising.
When undergoing corticosteroid treatment, older patients are monitored for bone density and blood pressure changes. Doctors may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. Lifestyle changes and medication may be prescribed to control blood pressure.
Polymyalgia rheumatica and temporal arteritis are closely related inflammatory conditions. Polymyalgia rheumatica is a disorder of the elderly characterized by muscular pain and stiffness in the shoulders, neck and pelvic muscles.
Headache affects more than two thirds of patients with TA. The following are some other symptoms of the condition: excessive sweating, fever, muscle aches, malaise, jaw pain, loss of appetite, scalp tenderness, vision problems, weakness, fatigue, weight loss, coughing, bleeding gums and mouth sores.
The most serious complication of temporal arteritis is irreversible vision loss. Prompt treatment is critical to prevent permanent damage to the eyes.
There are other possible complications. TA doubles your risk of an aneurysm, which is a bulge in a weakened blood vessel that can burst. In some cases, a blood clot may form in an affected artery causing a stroke.
TA is diagnosed by assessing symptoms, finding abnormal blood flow and through an Erythrocyte Sedimentation Rate (ESR) blood test that measures the rate at which red blood and other cells settle towards the bottom of a tube. A rapid or high rate usually correlates with ongoing inflammation. This test is good but not perfect.
A temporal artery biopsy may confirm the diagnosis. The biopsy is taken from a part of the artery located in the hairline, in front of the ear. The biopsy is helpful in most cases, but in some individuals it may be negative or normal, even though the disease is present.
Once a diagnosis of TA has been made, treatment should be started as soon as possible.