Overdiagnosis of temporal arteritis

Temporal arteritis is not a common disease, but it is often incorrectly diagnosed in elderly patients with a high ESR and pain in the temporal area. Such an incorrect diagnosis can subject the patient to needless biopsy and the serious side effects of therapy with large doses of prednisone. When temporal arteritis is suspected yet presentation is atypical, careful consideration should be given to ENT and neurologic examination, and even psychiatric evaluation. Temporal artery biopsy should be done on the tender side, with multiple serial sections. A negative biopsy does not rule out temporal arteritis. Therapy should not be deferred until biopsy results are reported. It consists of 40 to 60 mg of prednisone daily for at least four to six weeks with a gradual decrease thereafter.