Temporal arteritis: diagnostic and therapeutic considerations

Giant cell arteritis of surgical significance includes two clinical entities, temporal arteritis and Takayasu's arteritis, and they are pathologically indistinguishable from one another. This study summarizes our experience in 21 cases of temporal arteritis during a recent 5-year period. Patient Population and Results: This study includes patients who were discharged with a clinical diagnosis of temporal arteritis. There were 12 women and 9 men, with a mean age of 69 years. Six patients were admitted with an initial diagnosis of polymyalgia rheumatica, nine with severe headache and/or nonspecific symptoms, three with ischemic symptoms of the limbs, one with a cerebrovascular accident, one with syncope, and one with osteomyelitis of the limb. The sedimentation rate ranged from 26 to 110, with a mean of 41. Eight patients had a preoperative duplex ultrasound of their temporal arteries; six of these had a peak systolic velocity of 2 > or = 200 cm/s, and five had a positive temporal artery biopsy. Nineteen patients had temporal artery biopsies, 15 were positive for giant cell arteritis, and the diagnosis was not conclusive in 4. All patients were treated with prednisone with a satisfactory outcome, except for two who had ischemic symptoms of the upper extremity requiring a carotid-axillary artery bypass in one and a carotid-brachial artery bypass in the other. Both patients had satisfactory outcomes after surgery.

The primary treatment of temporal arteritis is medical, and surgery should be reserved for severe specific disabling symptoms that have failed medical therapy. Duplex ultrasound might be helpful in predicting the side and location for temporal artery biopsy.