Temporal Arteritis (Giant Cell Arteritis)

What is temporal arteritis?

Temporal arteritis (TA), or giant cell arteritis (GCA), is a form of vasculitis (inflammation of your blood vessels) that affects the arteries of your scalp, neck and arms. With this condition, most commonly your temporal arteries (the blood vessels near your temples) become inflamed (swollen) and constricted (narrowed). Your temporal arteries supply blood from your heart to your scalp, jaw muscles and optic (eye) nerves. Inflammation and narrowing of these arteries interrupts blood flow, leading to damage of your vital organs and tissues.

Temporal arteritis can involve other blood vessels, like your posterior ciliary arteries (leading to blindness), or large blood vessels like your aorta and its branches, which can also lead to serious health problems.

Other names for the condition include cranial arteritis and Horton’s arteritis. Temporal arteritis is commonly associated with another health condition called polymyalgia rheumatica (PMR).

Is giant cell arteritis a serious condition?

Yes. If not diagnosed and treated quickly, giant cell arteritis can cause:

• Damage to your eyesight, including sudden vision loss or blindness in one or both eyes.
• Damage to your blood vessels, like an aneurysm (a ballooning blood vessel that may burst).
• Other disorders, including stroke or transient ischemic attacks (“mini-strokes”).

How common is temporal arteritis?

Temporal arteritis is one of the most common vascular disorders, but it’s a relatively rare condition, affecting about 5 out of every 10,000 people.

What are the symptoms of temporal arteritis?

The most common giant cell arteritis symptom is a throbbing, continuous headache on one or both sides of your forehead. Other temporal arteritis symptoms may include:

• Fatigue.
• Fever.
• Jaw pain that may become worse after chewing.
• Tenderness at your scalp or temples.
• Vision problems, like double vision, blurry vision or transient (brief) vision loss. If this isn’t treated, it could be followed by permanent, irreversible vision loss.
• Muscle aches in your upper arms or shoulders, hips, upper thighs, lower back and buttocks.
• Loss of appetite or weight loss.

Healthcare providers often associate temporal arteritis with a condition called polymyalgia rheumatica (PMR), which is an inflammatory condition affecting your shoulders, hips and neck. This leads to significant stiffness and pain. PMR is far more common than temporal arteritis, but up to 50% of people with temporal arteritis have PMR.

What causes temporal arteritis?

Researchers don’t know the exact cause of temporal arteritis, but many believe it’s an autoimmune or autoinflammatory disease. That means your body’s immune system may accidentally “attack” your healthy blood vessels. In addition, because the condition mainly affects people as they age, it could be linked to the aging process. Scientists also believe genetics and environmental factors, like infections, may play a role.

Is temporal arteritis caused by stress?

Researchers have found a connection between the development of temporal arteritis and stress. One small study showed that previous stressful events can have an influence on the development of the condition. The study showed that some people who’d lived through adverse conditions within the past two years had developed temporal arteritis.

What are the risk factors for giant cell arteritis?

While the cause of giant cell arteritis isn’t fully understood, there are known risk factors for the condition, including:

• Age: The condition almost always affects people over the age of 50. And it seems to become more common as people age. It’s most common between the ages of 70 and 80.
• Sex: People assigned female at birth (AFAB) experience the condition more often than people assigned male at birth (AMAB). Although, people AMAB are more likely to experience blindness due to the condition.
• Ethnic and racial background: Temporal arteritis affects caucasian people, especially people of Northern European ancestry, more often than any other ethnic or racial group.

How is temporal arteritis diagnosed?

Your healthcare provider will ask about your medical history and perform a physical examination. They’ll check to see if your pulse is weak. They’ll also examine your head to look for scalp tenderness or swelling of your temporal arteries.

What tests will be done to diagnose giant cell arteritis?

Your healthcare provider will first order blood tests, like erythrocyte sedimentation rate and C-reactive protein, to measure how much inflammation (swelling) you have in your body. They may also test for anemia by measuring your hemoglobin level (the part of red blood cells that carries oxygen).

If they suspect temporal arteritis, your provider may order a temporal artery ultrasound or temporal artery biopsy, in which they remove a small piece of your artery and examine it for evidence of inflammation within your vessels.

Other tests that are sometimes necessary include:

• Positron emission tomography (PET) scan: A provider injects a very small dose of a radioactive chemical into a vein in your arm so they can follow it on a PET scanner via 3D pictures.
• Ultrasound: An ultrasound sends high-frequency sound waves through your body tissues. The echoes are recorded and turned into photos of the inside of your body.

How is temporal arteritis treated?

Temporal arteritis treatment should begin immediately to prevent vision loss. The main medication choice for the condition is glucocorticoids, like oral prednisone. You may need to take glucocorticoids for up to two years, sometimes longer. You’ll likely start at 40 mg to 60 mg per day, and your provider will gradually reduce your dosage. You’ll take this medication by mouth (orally).

Since there are serious side effects associated with the long-term use of corticosteroids, your provider will watch you carefully while you take these drugs. Side effects include a greater chance of fractures (because steroids can make your bones thinner) and infections (because steroids suppress your immune system).

In 2017, the U.S. Food and Drug Administration approved a biologic medication called tocilizumab as a giant cell arteritis treatment. You’ll receive this medication as a subcutaneous (through your skin) injection or through an IV (intravenous). This medication can help decrease your need for a corticosteroid.

Your provider may also recommend supplements like calcium and vitamin D, and exercises like walking or weight-bearing exercises to prevent osteoporosis.

Can temporal arteritis be prevented?

Researchers don’t know the exact cause of temporal arteritis, so you can’t prevent the condition.

What is the life expectancy of someone with temporal arteritis?

The outlook (prognosis) for temporal arteritis (giant cell arteritis) is very good. With early diagnosis and treatment, symptoms generally start to improve within days. With continued medical care and treatment, many people with the condition recover fully within one to two years. Most people have a typical life expectancy with early treatment. But even with treatment, the condition may return. Researchers aren’t completely sure why relapses occur, but infections may be a trigger.

Without early treatment, the condition can lead to permanent vision loss, stroke and aneurysms. It’s important to see your healthcare provider right away if you experience any of the symptoms associated with temporal arteritis. If you’re experiencing symptoms of complications, like stroke, call 911.

How do I take care of myself?

Living with temporal arteritis can be challenging. To manage your condition and the side effects you may experience from corticosteroids, make sure you:

• Eat healthy, nutritious foods, like lean meats, whole grains and fresh fruits and vegetables.
• Get enough vitamin D and calcium to protect your bones.
• Stay active with some sort of physical activity at least 30 minutes a day.
• Get at least seven to eight hours of sleep every night.
• Take your prescribed medications as directed.
• Visit your healthcare provider regularly.

What should you avoid with temporal arteritis?

There are certain things you should avoid if you have temporal arteritis. These include:

• Drinking alcohol: Alcohol can have a negative effect on your heart and blood vessel health. It can also speed up bone loss, and it may interact with medications you have to take for your condition.
• Smoking: Smoking can increase your risk of developing temporal arteritis. Your blood vessel health will improve right away when you quit, and it’ll have lifelong benefits.
• Getting sick: Certain medications can weaken your immune system. To avoid getting sick, make sure to wash your hands, stay away from people who are sick and ask your healthcare provider about vitamins and supplements.

When should I see my healthcare provider?

If symptoms of temporal arteritis return, call your healthcare provider right away. Seeing your provider frequently and getting ongoing lab and imaging tests can help them detect a relapse early.

If you experience any side effects from your corticosteroid medication, call your provider. They may have to lower your dose. Side effects of corticosteroids may include:

• Weight gain.
• Swelling, especially in your face and legs.
• Muscle loss.
• High blood pressure (hypertension).
• Vision problems.
• Mood swings.
• Insomnia.

What questions should I ask my healthcare provider?

Questions to ask your healthcare provider include:

• What caused my condition?
• What treatments do you recommend?
• What side effects of the treatment should I watch out for?
• Do I have polymyalgia rheumatica, too?
• What complications can this condition cause?
• What can I do to prevent a relapse?

A note from Cleveland Clinic

Temporal arteritis, or giant cell arteritis, can be a challenging condition to live with. Symptoms of the condition and side effects of the treatment can take a great toll on your sense of well-being. It can also affect your work and many other aspects of your life. But you don’t have to go through it alone. Ask your healthcare provider to help you find a support group. Sharing stories and tips with others experiencing temporal arteritis may help.