Temporal arteritis

Temporal arteritis: description

Temporal arteritis, also called Horton’s disease, giant cell arteritis or cranial arteritis, is a rheumatic vascular disease. Mostly large and medium sized vessels are affected. Most commonly, the disease occurs at branches of the carotid artery. These vessels supply the temporal region, the back of the head and the eyes with blood. In about every fifth patient, temporal artery temporal artery affects the main artery. In less than one percent are involved heart disease, brain or other organ arteries.

Temporal arteritis is one of the autoimmune diseases. Because in the affected vessels Certain cells accumulate the immune system (Granulocytes and lymphocytes) and form a chronic inflammation. Under the microscope you can also very large cells, so-called giant cells, detect. The disease, which is today mostly called giant cell arteritis, causes cells of the vessel wall to multiply, and finally the constrict affected vessel, As a result, especially under physical stress, the blood supply is no longer sufficient. Depending on the organ system corresponding symptoms are produced.

Temporal arteritis is also referred to as Horton’s disease or Horton’s temporal arteritis, according to its discoverer. It is one of the most common rheumatic vascular diseases. According to the German Society of Neurology, between 12,300 and 24,600 people in Germany suffer from temporal arteritis. Almost all of these patients are over 50 years old. Most of them fall ill by the age of 70. Women are about three times more likely to be affected by giant cell arteritis.

Temporal arteritis: symptoms

Almost all patients with temporal horton arteritis have special strong headache. However, most of them have general symptoms of illness that affect the eyes, heart, circulation, or nervous system well before the first headache.

Headache in temporal arteritis

Over 70 percent of people with temporal arteritis suffer from new, severe headaches. These are mostly called boring to piercing described and usually occur a temple side on. The pain increases when affected chew, cough or turn your head, This is because it affects an artery that supplies the masticatory muscles with oxygen and nutrients. Chewing Affected solid food, the masseter is more stressed and needs more nutrients. If the care of a damaged artery can not be guaranteed, pains in the area of ​​the temples, the scalp or a painless feeling of pain may occur lockjaw on (Claudicatio masticatoria). Partially, sufferers must take a break during a meal.

Visual disturbances in temporal arteritis

If arteritis affects temporal vessels on the eye, both the optic nerve and the eye muscles may be restricted. The optic nerve needs to be constantly supplied with blood just like the muscles. The supplying arteries can change morbidly blurred vision occur. These include fleeting interruptions (Amaurosis fugax), in which those affected suddenly suddenly see nothing in one eye. If only part of the image fails, it is called one scotoma, Under certain circumstances, visual impressions are perceived as flickering images. If the eye muscles are supplied with too little blood, double vision, a pain in the gaze or a drooping eyelid may occur. In the worst case, sufferers become blind due to ateritis temporalis.

Other symptoms of temporal arteritis

For some time before the typical headache of temporal arteritis occurs, sufferers often suffer non-specific disease symptoms, You feel cut off or have a slightly elevated body temperature again and again. If only the main artery is attacked in giant cell arteritis, fever may be the only disease symptom. In addition, lack of appetite and weight loss are concomitant symptoms of temporal arteritis. These symptoms can be similar to a tumor disease and therefore make the doctor easily think of the wrong diagnosis.

Less than two percent of the disease affects not only the arteries on the outside of the head, but also the internal vessels. As a result, brain regions can not be sufficiently supplied with oxygen and nutrients – this can lead to strokes with symptoms such as paralysis, speech or dizziness.

In principle, in Horton’s disease, every nerve in the body may be affected if the supplying blood vessel is restricted. As a result, the feeling of the skin or even individual muscle movements can worsen. Rarely, the function of the heart, kidneys or lungs are impaired.

If the main artery is affected, the blood pressure between the two arms may be different. In addition, some sufferers a tactile pulse on the wrist disappears. Other sufferers suffer from pain in the arms, especially when they are under stress. If it is a section of the main artery in the thorax, more often arise sloughing (aneurysm) and vessel tears (dissections), which can be life-threatening.

In 30 to 70 percent of cases, temporal arteritis occurs as part of a polymyalgia rheumatica. Affected then additionally suffer from pain in the shoulder, the pelvis or the neck muscles. This pain, unlike the typical headache, is usually symmetrical and does not develop quite so suddenly. In addition, morning stiffness may persist, improving during the day. Even depressive moods are not uncommon.

Temporal arteritis: causes and risk factors

Temporal arteritis is a rheumatic disease in which the Immune system works incorrectly. Certain immune cells, called T cells, cause an autoimmune reaction. Why this happens has not been researched enough. Maybe the disease is going through infections caused by viruses (chickenpox, marigold) or bacteria (Mycoplasma pneumoniae, chlamydia).

Since not all people with such infectious diseases develop temporal arteritis, there is probably one genetic susceptibility, People with certain proteins on white blood cells (HLA-DR4) are more prone to this condition. In addition, temporal arteritis is more common in people with polymyalgia, another rheumatic pain disorder.

Temporal arteritis: examinations and diagnosis

The right contact person for suspected temporal arteritis is a specialist in rheumatoid diseases (rheumatologist) or nervous disorders (neurologist). An American Working Group on Rheumatoid Diseases (ACR) has put together a set of criteria that your doctor can use to diagnose temporal arteritis. For this he first leads a medical consultation (anamnese) and in case of existing suspected disease then imaging and tissue removal by. A blood test could show elevated levels of inflammation. If at least three of the following five criteria apply to one individual, there is a likelihood of more than 90% of arteritis temporalis:

• Age over 50 years
• First or new headache
• Altered temporal arteries (painful, weaker pulse)
• Increased erythrocyte sedimentation rate (blood test)
• Tissue changes of a temporal artery

Further investigations

In most cases, a specific ultrasound performed on the temporal arteries. The temporal artery can also with a magnetic resonance imaging (MRI). For this purpose, the person concerned is first injected with a specific contrast agent into a vein, before he is driven on a movable couch with his head in the MRI tube. For this investigation certain technical requirements are necessary, which can often only be met in specialized centers. However, vascular changes of other arteries can also be displayed.

A limitation of the blood supply caused by the arteritis temporalis can with the Positron Emission Tomography (PET) will be examined in more detail. The examination procedure is similar to that of an MRI examination. In particular, PET is performed when the aorta or other organ systems are affected, when patients suffer from marked concomitant symptoms, or when tissue sampling does not allow a clear diagnosis.

Tissue removal in temporal arteritis

If signs of disease and imaging tests indicate temporal arteritis, in many cases a tissue sample (biopsy) taken from the affected temporal region and examined under the microscope. Since the disease is not detected in every patient in an ultrasound examination, a tissue sample should be taken even with an inconspicuous ultrasound result. In some cases, an artery piece is also removed from the other temporal side.

Temporal arteritis: treatment

After a temporal arteritis has been diagnosed, the person should immediately with a cortisone be treated. The first four weeks, a dosage of one milligram of prednisolone per kilogram of body weight is recommended. If the symptoms have disappeared due to the therapy and the inflammation levels in the blood have normalized, the dose should be continuously reduced. If symptoms appear again, more prednisolone must be taken again. The doctor treating the patient with his patient will draw up an exact intake schedule. If blindness is imminent, prednisolone therapy must be given in high doses over the vein for three to five days.

Because cortisone therapy can cause many undesirable side effects, more medicines need to be taken. Calcium and vitamin D reduce the risk of developing osteoporosis (brittle bones). Against possible vascular occlusions, an aminosalicylate (for example, aspirin) should be taken. A proton inhibitor protects the stomach lining. In addition, the blood sugar should be checked regularly and treated if necessary.

Temporal arteritis: disease course and prognosis

Without therapy, about 30 percent of those affected go blind. With early diagnosis and subsequent therapy, however, the symptoms disappear permanently in almost all patients. Rarely does the condition occur repeatedly or is it chronic Temporal arteritis above.