Temporal arteritis: symptoms and treatment

Temporal (temporal) arteritis is a chronic inflammatory disease of vessels with a lesion of the walls arteries of large and medium caliber and the primary involvement of the temporal artery in this process. It is also called Horton's disease (by the name of a doctor who in 1932 gave a detailed description of this pathology) or giant cell granulomatous arteritis. The clinical picture consists of the signs of the systemic inflammatory process and the disturbance of the functioning of organs suffering from hypoxia (lack of oxygen).

How arteritis develops

Temporal arteritis is described in the first half of the last century, but the exact reasons for its development have not yet been elucidated. It is known that the inflammation of the arterial wall is caused not by direct damage or exposure to microorganisms, but by autoimmune cell damage.

Primary production of antibodies can be triggered by a malfunction of the immune system after exposure to viruses and certain bacteria. Viruses can change the antigenic composition of cells in the human body, which will be perceived by the immune system as the appearance of alien harmful agents. The produced protective complexes (antibodies) will be attached to the walls of the vessels and destroy them. As a result, inflammatory foci appear in the walls of large and medium arteries.

Initially, the vascular walls are infiltrated and thickened, then in the foci of inflammation granulomas - clusters of cells are formed. At the same time, histological examination reveals plasma cells, lymphocytes, eosinophils, histiocytes and giant multinucleated cells. It is because of them that the disease got its name, although not all patients with a classic clinical picture reveal giant cells.

Because of inflammation, the vessels become thickened, with an uneven surface, and thrombi can be found inside them. In this case, not all the artery area is affected, but only individual segments. This process is asymmetric and most often captures the temporal artery. Vertebrates, posterior ciliary, eye arteries and the central artery of the retina are also often involved. Other changes can be found in the carotid, subclavian, mesenteric and iliac arteries, occasionally in the coronary arteries. And with inflammation of the aortic wall, aneurysms form in it.

Main symptoms

All clinical signs of temporal arteritis can be divided into several groups:

• general symptoms of inflammation in the form of weakness, increased body temperature (infrequently), sweating, fatigue, weight loss;
• local symptoms associated with the defeat of superficial arteries (temporal, occipital) in the form of headaches, local soreness when touching the skin above the affected vessel, sometimes bulging and tortuosity of the artery;
• signs of inadequate functioning of organs receiving insufficient oxygen because of constriction and thrombosis of affected arteries.

Headache with temporal arteritis can be spilled or unilateral, in this case it resembles a migraine. The pain increases with chewing, touching the temple, it has a pulsating character.

Giant cell arteritis very often leads to pathology on the part of the eye, which is often associated with inflammation of the eye arteries (departing from the external carotid arteries), affecting the central artery of the retina and the smaller ciliary arteries. This can lead to poor eyesight and even to severe development of blindness. And with the defeat of the vertebral arteries, there may be double vision (diplopia) and ovulation of the upper eyelid (ptosis). This is due to the ischemia of the nuclei of the cranial nerves in the medulla oblongata, which are responsible for the muscles around the eyeball.

Inflammation and subsequent thrombosis of various arteries can cause angina, attacks of weakness and pain in the limbs and tongue with exercise, abdominal pain, cerebral ischemia with the development of various neurological and psychiatric disorders. Occasionally, with a pronounced narrowing of the arteries, there are necroses of the limbs, skin areas.

It happens that the temporal arteritis is combined with the syndrome of rheumatic polymyalgia, manifested by pain in the muscles and a feeling of stiffness. Therefore, patients with such symptoms should be further examined to exclude giant cell arteritis.

Diagnostic Issues

Angiography reveals changes in arterial wall that are characteristic of arteritis.

If a person has symptoms of temporal artery disease, then the diagnosis of giant cell arteritis is very likely. If the defeat of other arteries prevails, the disease may remain unconfirmed for a long time. The patient will go to doctors of different profiles and receive symptomatic therapy that does not affect the course of the underlying pathological process. Only a comprehensive assessment of all existing abnormalities, combined with additional examinations, will clarify the cause of numerous violations. And such a diagnosis, unfortunately, is rarely done when the first symptoms appear.

For the detection of giant cell arteritis, a number of examinations are used:

• general examination with assessment of pulsation of various arteries;
• revealing changes in shallow located arteries: uneven thickening of their walls, soreness, the appearance of noise in them;
• consultation of the oculist with definition of a picture of an eyeground;
• UAC, which allows to reveal a pronounced increase in ESR, moderate normo- or hypochromic anemia;
• determination of the level of CRP (C-reactive protein), an increase in this indicator indicates an active inflammatory process;
• biopsy of the temporal arteries to detect characteristic changes in its wall;
• Ultrasound of vessels, angiography: allow to see segmental changes in the walls of the arteries, leading to a narrowing of the arteries lumen.

In this case, biopsy allows to reliably confirm the disease, and the remaining laboratory methods are indirect and allow you to establish a diagnosis in conjunction with a characteristic clinical picture.

Treatment

Patients with temporal arteritis are observed and treated by a rheumatologist, although primary diagnostics are often conducted by physicians of other specialties.

The main method of treatment of temporal giant cell arteritis is corticosteroid therapy. Hormones are prescribed in a sufficiently high dosage (50-60 mg / day) immediately after confirmation of the diagnosis, during a few days in the absence of sufficient reaction the doctor may recommend increasing the dose by another 10-25 mg. The first slight decrease in dosage is possible only after 4 weeks, while the level of ESR is necessarily monitored. With a stable patient and good laboratory data, a slow stepped cancellation of the drug, on average, the total duration of corticosteroid therapy takes 10 months.

In addition to such basic therapy, symptomatic treatment is prescribed to improve the rheological properties of blood, normalization microcirculation in the tissues suffering from hypoxia, maintenance and restoration of functioning of organs. Vascular drugs, disaggregants are prescribed, sometimes heparin is required.

Giant cell arteritis most often affects the elderly, who already have other chronic diseases and age-related metabolic disorders. Therefore, in the treatment it is necessary to regularly evaluate the functioning of the liver and the parameters of the mineral metabolism, which will allow to reveal in time the development of hepatic insufficiency or osteoporosis. In addition, the prevention of the occurrence of steroid ulcers of the stomach and duodenum, the level of glucose in the blood is monitored.

With the development of acute thrombosis in the lumen of inflamed arteries, the threat of rupture of the aortic aneurysm may require surgical intervention.

Forecast

Completely get rid of violations at the immune level is impossible. But competent therapy can suppress the activity of the inflammatory process and prevent the development of formidable complications - heart attack, blindness, stroke. Against the background of steroid therapy, the main symptoms of the disease quickly stop, the laboratory indicators are gradually normalized. In 2 months after the beginning of a full-fledged treatment, the examinations can show a significant improvement in the condition augmentation of the lumen of the affected arteries and the restoration of normal blood flow.

With timely treatment begun, the forecast is favorable, so do not rely on self-healing or folk methods, wasting time and exposing yourself to the risk of developing formidable complications.

The first channel, the program "Live Healthily" with Elena Malysheva on "Horton's Disease (Temporal Arteritis)":

Horton's disease, temporal arteritis Symptoms Treatment of Horton's Disease

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