Dear Doctor Column, September 13, 2004

Question:

I have been diagnosed with temporal arteritis, which was confirmed with a biopsy on both sides of my scalp. I would like to know more about this disease, including cause and treatment. I have been on prednisone for 8 months. Thanks for any information you can give me.

Answer:

Giant cell arteritis is an uncommon condition in which certain arteries in the body become inflamed. It sometimes is called temporal arteritis or cranial arteritis, because it frequently affects the arteries in the scalp near the temples. However, it also can involve other arteries in the head, neck, and arms, and occasionally, other areas.

Inflammation in this condition is characterized on microscopic examination by the presence of "giant" cells that narrows or blocks the arteries, depriving the downstream tissues of adequate blood supply.

Primarily affecting people aged 50 years and older (average age 70), the cause of the disease remains unknown. It occurs twice as often in women as in men and whites have a stronger predisposition for the disease; African Americans and Asians rarely develop giant cell arteritis. Also at high risk are people with polymyalgia rheumatica, another poorly understood condition characterized by morning stiffness, pain, and tenderness in the shoulders, hips, and neck; about 50% of people with giant cell arteritis will have polymyalgia, and 10% of people with polymyalgia develop arteritis.

Giant cell arteritis can produce symptoms such as pain in the jaw muscles when eating or talking, severe headaches, and tenderness over the inflamed vessels in the temples. When blood vessels that nourish the eyes are involved, blindness in one or both eyes can suddenly develop. Historically, up to 30% of those suffering from temporal arteritis developed permanent blindness in one eye. Today, suppression of the inflammation with prednisone offers effective relief of symptoms, while preventing blindness and other disabilities, such as stroke. However, you should report any vision problems to your physician at once.

The diagnosis of giant cell arteritis is confirmed by a biopsy of the temporal artery. The large doses of cortisone-like drugs, such as prednisone, suppress inflammation in the artery walls. As the inflammation subsides, the dosage is reduced, and the drug can be discontinued in most cases, although treatment often continues for a year or longer.

Although prednisone does have side effects, the high risk of permanent blindness and other problems related to blocked blood vessels justifies its use in individuals diagnosed with the disease. Side effects of high-dose prednisone taken long-term include weight gain, redistribution of body fat, fluid accumulation, thin skin and easy bruising, and mood swings and depression. More serious complications can include osteoporosis, stomach ulcers, high blood pressure, diabetes, and an increased risk of infections. Your physician will monitor your condition closely, checking for side effects, decreasing the dose of prednisone to safer levels as soon as possible.

Another treatment approach is to use low doses of the anticancer drug methotrexate in combination with prednisone.

For more information, visit the American College of Rheumatology Web site or the Arthritis Foundation Web site.