Temporal arteritis: the silent presentation and delay in diagnosis.

Area of Science:

• Rheumatology
• Internal Medicine
• Vascular Medicine

Background:

• Temporal arteritis (TA) is a serious condition often presenting with characteristic symptoms.
• A subset of TA cases exhibit a 'silent' or occult presentation, characterized by constitutional symptoms alone.
• This atypical presentation can lead to diagnostic delays and potentially adverse outcomes.

Purpose of the Study:

• To investigate the frequency of the silent/occult presentation of temporal arteritis.
• To determine the impact of this presentation on the delay of diagnosis.
• To highlight the importance of recognizing atypical TA symptoms for timely intervention.

Main Methods:

• Retrospective analysis of medical records of patients diagnosed with temporal arteritis or polymyalgia rheumatica between 1982 and 1988.
• Inclusion of only biopsy-proven cases of temporal arteritis (n=34).
• Comparison of diagnostic delays between patients with typical and silent/occult presentations.

Main Results:

• 13 out of 34 (38%) biopsy-proven temporal arteritis cases presented with the silent/occult form.
• Patients with the silent/occult presentation experienced a significantly longer mean diagnostic delay (21.5 days) compared to those with typical symptoms (8.5 days).
• Statistical significance was observed in the difference of diagnostic delays (P < 0.05).

Conclusions:

• The silent/occult presentation of temporal arteritis occurs frequently (38%) and is associated with significant diagnostic delays.
• Enhanced clinical awareness of this presentation is essential for prompt diagnosis and treatment of temporal arteritis.
• Earlier diagnosis and treatment can lead to reduced hospital stays, fewer investigations, and potential financial savings.