Cranial arteritis. A twenty-year review of cases

Thirty-five cases of cranial arteritis in an Australian population have been analysed. The female to male ratio was 2.2:1 and the average age of onset was 71 years. Eighty-five percent of patients suffered headache and this was most frequently temporal or bitemporal. Polymyalgia rheumatica (40%), permanent visual loss (29%) and jaw claudication (26%) were common, six patients complained of diplopia and four gave a past history of thyroid disease. The temporal artery was clinically abnormal in only 69% of cases but biopsy was positive in 26 of 28 specimens examined. Sixty-seven percent of patients had ESR's greater than 60 mm/h. The average duration of prednisone therapy was 22 months. Side effects of steroids were observed in seven of 19 patients followed up. The importance of starting steroid therapy as soon as the condition is suspected clinically is emphasised by the case of one patient who lost vision while awaiting temporal artery biopsy.