Temporal Arteritis: Causes, Symptoms, Treatment and Cost

Temporal arteritis, commonly known as giant cell arteritis, is an inflammatory condition of the blood vessels.

• Giant Cell Arteritis (GCA): This is the most usual kind of temporal arteritis, which leads to inflammation of the arteries in the head, neck, and arms. It can cause headaches, vision problems and jaw pain.
• Takayasu arteritis: This kind of temporal arteritis is an uncommon inflammatory vascular condition affecting the aorta and its branches. It can cause severe headaches, dizziness, fatigue, fever and high blood pressure.
• Polymyalgia Rheumatica (PMR): This type of temporal arteritis is characterised by muscle pain and stiffness in the shoulder, hip or neck area that may be accompanied by low-grade fever, fatigue and anaemia.

The specific aetiology of temporal arteritis is unclear, however various variables may be linked, including:

• Genetic predisposition: Certain genetic factors may make a person more susceptible to developing temporal arteritis.
• Exposure to certain viruses or bacteria: Infection with certain viruses and bacteria may trigger an immune response that leads to temporal arteritis.
• Age: The chance of having temporal arteritis rises with age and is most prevalent in those over the age of 50.
• Smoking: Smoking has been linked to increased risk of developing temporal arteritis, presumably due to its effects on the immune system and inflammation pathways in the body.

Some of the symptoms of temporal arteritis are:

• Headaches: Generally, the pain is located around or behind the eyes and forehead. It may just affect one side of the head or both.
• Jaw Pain/Difficulty Chewing: Jaw pain may be experienced when chewing, and there may be difficulty opening and closing the mouth.
• Vision Problems: Blurred vision, double vision, or complete loss of vision in one or both eyes is a common symptom of temporal arteritis.
• Scalp Tenderness: Scalp tenderness around the temporal artery may be experienced due to inflammation in the area.
• Fever/Fatigue: Fever and fatigue are also common symptoms of temporal arteritis.

• Eat a balanced and healthy diet with plenty of fruits and vegetables.
• To keep your weight in check and lower stress, engage in regular exercise.
• Avoid smoking and secondhand smoke since they both raise the chance of getting vasculitis.
• Limit the use of medications like non-steroidal anti-inflammatory drugs (NSAIDs) and oral steroids, which may increase risk of developing temporal arteritis.
• Get an annual checkup with your doctor as early diagnosis can prevent permanent damage to vision or other organs in case of temporal arteritis development.

• Physical examination: A physical examination of the head, neck, and temporal region can help diagnose temporal arteritis.
• Blood tests: Temporal arteritis may be diagnosed with blood tests such as an erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). An increased ESR or CRP level shows bodily inflammation, which may be produced by temporal arteritis.
• Biopsy: A biopsy of the temporal artery is the most accurate way to diagnose temporal arteritis. During this procedure, a small piece of tissue is taken from the artery and examined under a microscope for inflammation and other signs of disease.
• Imaging tests: Imaging procedures such as Doppler ultrasound and magnetic resonance imaging (MRI) may also be used to identify temporal arteritis. These tests can help visualise any narrowing or blockages in the arteries that may be caused by the disease.

• Visual Loss: May occur due to damage of the posterior ciliary arteries causing ischaemic optic neuropathy.
• Branch Arterial Occlusive Disease: Usually affects the arteries of carotid triangle such as superior thyroid artery, ascending pharyngeal artery, occipital artery and transverse facial artery etc.
• Cranial Nerve Palsy: Patients sometimes present with facial, trigeminal & other cranial nerve palsy which is secondary to neurovascular compression leading to ischaemia and infarction of the affected cranial nerve.
• Deafness: Rarely hearing can also be affected due to involvement of cochlear arteritis leading towards sudden onset deafness or vertigo.
• Giant Cell Arteritis (GCA): GCA is an autoimmune condition where excess production of inflammatory mediator results in thickening and narrowing of vessel wall which leads to loss in blood supply.

• Abhyanga: Abhyanga is a type of Ayurvedic massage which is used to increase blood circulation and reduce inflammation. It involves using warm oil on the body to massage the affected area. This helps to improve circulation and reduce swelling in the temporal arteries.
• Panchakarma: Panchakarma is an ancient system of cleansing and detoxification used in Ayurveda to eliminate toxins from the body. It can be used to help with Temporal Arteritis by reducing inflammation in the affected areas.
• Herbal Remedies: Certain herbs such as turmeric, guduchi, ashwagandha, and amalaki can be used to reduce inflammation and pain associated with Temporal Arteritis. These herbs include anti-inflammatory qualities that may aid in the reduction of swelling and discomfort in the afflicted regions.
• Exercise: Regular exercise can help increase blood flow to the temporal artery and reduce pain associated with Temporal Arteritis. Low-impact exercises such as walking or swimming are recommended for people suffering from this condition as they will not put too much strain on the affected area.

• Eating a well-balanced diet that is low in saturated fat and high in fibre is important for people with temporal arteritis.
• Foods that are rich in antioxidants, such as fruits, vegetables, whole grains, and nuts, may help reduce inflammation associated with temporal arteritis.
• In addition, eating foods rich in omega-3 fatty acids, like salmon and mackerel, may help bring down inflammation levels.
• In order to lower inflammation and enhance general health, drinking lots of water throughout the day is essential.

Those who suffer from temporal arteritis should avoid eating a number of items. Examples of these are:

• Foods high in fat and cholesterol: High-fat and cholesterol-rich foods may aggravate temporal arteritis symptoms by increasing inflammation.
• Processed meats: Processed meats, like hot dogs and bacon, include preservatives and other ingredients that might induce inflammation.
• Refined carbohydrates: Refined carbs, such as white bread and crackers, may produce a rise in blood sugar levels, which can lead to inflammation in the body.
• Excess sugar: Too much sugar has been linked to increased inflammation and should be avoided when living with temporal arteritis.
• Alcohol: Alcohol is known to increase inflammation in the body and should be avoided when living with temporal arteritis.

• Medications: Medications may be used to treat pain or discomfort brought on by temporal arteritis and decrease inflammation associated with it.
• Surgical decompression: This entails removing portions of the temporal artery and other damaged tissues in order to relieve pressure on the artery and eliminate inflammations.
• Intermittent Arterial ligation: It is a method in which an elastic band is used to seal off small arteries in order to minimise swelling or inflammation induced by temporal arteritis.
• Embolization: When necessary, embolization can be done where occlusion agents are used to block off blood vessels that supply the affected artery. This reduces swelling and inflammation in the area.

A rheumatologist or an ophthalmologist is typically the best doctor to consult for temporal arteritis.

• Non-steroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, naproxen, etodolac, and meloxicam are examples. They function by lowering inflammation and alleviating pain in the afflicted region.
• Corticosteroids: These anti-inflammatory drugs may be administered orally or injected directly into the afflicted region. Prednisone, methylprednisolone, and dexamethasone are examples.
• Disease-modifying antirheumatic drugs (DMARDs): These drugs can help manage underlying systemic conditions associated with temporal arteritis such as rheumatoid arthritis or lupus. Examples include methotrexate and hydroxychloroquine sulphate.
• Biologic agents: Used to treat inflammatory diseases such as temporal arteritis that affects multiple organs in the body such as joints and skin, biologic agents are proteins manufactured from living organisms specifically designed to target certain substances in the body responsible for inflammation. Examples of biologic agents used to treat temporal arteritis include abatacept (Orencia), anakinra (Kineret), adalimumab (Humira).
• Immunosuppressants: These medications help prevent your immune system from attacking healthy cells in your body while allowing it to fight off disease or infection. Examples of immunosuppressants used to treat temporal arteritis include azathioprine, mycophenolate mofetil, cyclophosphamide, etc.

Generally speaking, recovery is usually seen within the first few weeks of treatment with corticosteroids.

According to the seriousness of the ailment, however, complete healing may take many months or even years.

Depending on the kind of therapy, the outcomes might vary from permanent to temporary.

For example, surgery may provide permanent results, while medications or other treatments may provide more temporary relief.

• Among the post-treatment recommendations for temporal arteritis are:
• Regularly monitoring blood pressure and laboratory tests to ensure steroid therapy is at an effective level and the inflammation has been reduced.
• Continuing low-dose steroids for up to 4 years following diagnosis, or as prescribed by a doctor, in order to reduce the risk of relapse.
• Regular physical exercise, such as regular walking or swimming, may help maintain fitness and enhance recovery.
• Avoiding exposure to extreme temperatures and nonsteroidal anti-inflammatory drugs (NSAIDs), both of which may aggravate symptoms of temporal arteritis.
• Eating a balanced diet that is rich in fruits and vegetables to boost immunity and help prevent flare ups of disease activity during remission periods.

Generally, the cost for medications can range from about ₹2,000 - ₹20,000.

Diagnostic tests like ultrasound or magnetic resonance imaging (MRI) may be needed to arrive at a diagnosis and these may incur extra charges, ranging from about ₹3,000 – 10,00 for MRI. Additional treatments also carry additional costs.

Some clinics also offer post-treatment follow-ups with specialist doctors which can add further expenses to the overall treatment costs.

• Steroid medication: Can cause insomnia, weight gain, mood swings, poor wound healing, adrenal gland suppression and increased risk of infection.
• NSAID medications: May cause nausea, vomiting, headache and gastrointestinal bleeding.
• Plaquenil: Can cause nausea, dizziness, headaches and nervous system side effects such as balance problems and blurred vision.
• Biologic Therapy: Can lead to serious infections or reactivation of dormant infections such as tuberculosis or hepatitis B virus (HBV).

Consult a doctor in your area if you are experiencing any Temporal Arteritis problems as they can lead to debilitating conditions like Branch Arterial Occlusive Disease, cranial nerve palsy, and deafness for which treatment regimens can last anywhere from a few months to years, depending on the severity of the condition.