Temporal Arteritis

Inflammation of the temporal artery, which runs along the sides of the forehead, this disease never occurs in persons younger than 50.  Most are over 60 or 70.  The danger is that it can cause sudden and permanent loss of vision.

We need to look for this in anyone of the right age with a new headache.  The pain may not be very severe, may wax and wane, ease up & return, but it’s present throughout the day, every day.  Other symptoms may (or may not) include jaw pain while eating or talking, minor fevers, achy shoulders and/or hips, or simply a new “just not feeling well.”

The first test we do is a simple blood test called the Erythrocyte Sedimentation Rate (ESR, “Sed Rate”) or C-Reactive Protein (CRP).  It gets high (sometimes very high) due to any kind of inflammation.  So if this is pretty normal, the diagnosis is very unlikely.

If the ESR is very high, we order a biopsy of the temporal artery, which I’m told is a simple procedure.ย  But so as not to risk loss of vision, we start protective treatment immediately with a high dose of prednisone (a steroid).ย  We need to get the biopsy within 2 weeks, or the prednisone might alter results.ย  Since treatment lasts 6 months or more, even 2 years, and prednisone has long-term risks if taken for over a month, we want the biopsy to be completely sure.

Biopsies can be done by general surgeons, plastic surgeons, or ophthalmologists (eye surgeons).  If we can’t schedule it quickly through one specialty, we try another.  If anyone takes high-dose prednisone for 5 days & doesn’t feel all better, they don’t have temporal arteritis.

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