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TEMPORAL ARTHRITISTemporal arthritis or giant cell arthritis is a systemic inflammatory illness that affects people over the age of 50. It generally starts slowly with the development of fatigue and malaise over several weeks. It may also cause low grade fevers and weight loss. Patients will also experience muscle and joint aches in their hips and shoulders but only rarely true joint swelling. As part of the inflammatory process, major large arteries are inflamed, in particular the temporal artery (artery at the side of head near the temples). Since the temporal artery supplies blood to the jaw and top of the head, symptoms include headache, scalp tenderness and soreness of the jaw after chewing or talking. The temporal artery also supplies the optic nerve and one of the most serious, and gratefully rare, complications of temporal arthritis is blindness. The treatment of choice for temporal arthritis is prednisone which is very effective. The major concern with temporal arthritis is vision loss, although if allowed to progress, it may affect arteries in other areas of the body. This condition is potentially vision threatening, however, if treated promptly, permanent vision loss can be prevented. Vision is threatened when the inflamed arteries obstruct blood flow to the eyes and optic nerves. If untreated, permanent vision loss can occur from oxygen deprivation to the retina and optic nerve. The cause of temporal arthritis is unknown but is assumed to be, at least in part, an effect of the immune response. The disorder has been associated with polymyalgia rheumatica. It has also been associated with severe infections, high doses of antibiotics, and chronic disorders such as rheumatoid arthritis and systemic lupus erythematosus. The symptoms occur because of inflammation. The disorder may exist independently or may coexist with or follow polymyalgia rheumatica (a disorder characterized by abrupt development of pain and stiffness in the pelvis and shoulder muscles). About 25% of people with giant cell arthritis also experience polymyalgia rheumatica. Symptoms of Temporal arthritis- • fever • a headache o on one side of the head or the back of the head o throbbing • scalp sensitivity, tenderness when touching the scalp • jaw pain, intermittent or when chewing • vision difficulties o blurred vision, double vision o reduced vision, blindness in one or both eyes • weakness, excessive tiredness • a general ill feeling • a loss of appetite • weight loss (more than 5% of total body weight) • muscle aches • excessive sweating Additional symptoms that may be associated with this disease- • mouth sores • joint stiffness • joint pain • hearing loss • gums, bleeding • face pain Signs and tests for temporal arthritis- Palpation of the head shows scalp sensitivity and often shows a tender, thick, palpable artery on one side of the head. The affected artery may have a weakened pulse or no pulse. About 40% of people will have other nonspecific symptoms such as respiratory complaints (most frequently dry cough) or mononeuritis multiplex (weakness and/or pain of multiple individual nerve groups). Rarely, ocular palsies (paralysis of eye muscles) may occur. Fever may be the only symptom (the person presents with a persistent fever of unknown origin). Blood tests are nonspecific. • A sedimentation rate (ESR) is almost always very high. • A hemoglobin or hematocrit may be normal or low. • Liver function tests may be abnormal if the disorder is systemic. • Alkaline phosphates may be elevated. A biopsy and analysis of tissue from the affected artery is also done. Treatment of Temporal arthritis- The goal of treatment is to minimize irreversible tissue damage that may occur because of lack of blood flow (ischemia). Corticosteroids such as Prednisone are commonly prescribed to reduce inflammation. If symptoms suggest cerebral vasculitis, corticosteroid treatment may be started even before a biopsy confirms the diagnosis (to reduce the risk of complications). Aspirin may be recommended in addition to corticosteroids. Medications that suppress the immune system (such as cyclophosphamide) are occasionally prescribed. |
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