Treatment for Temporal Arteritis: A Personal Experience
My Mother's Experience With Temporal Arteritis
A few years ago, my 83-year-old mother was diagnosed with temporal arteritis. It was a condition that I was unfamiliar with at the time of her diagnosis. However, I was to learn much more about it over the coming weeks.
It's actually a very serious condition, but when intervention is provided in time, it can be dealt with very successfully. For this reason, I wanted to share some of the information that I learned in order to increase awareness and potentially alert others to the symptoms so that this condition doesn't go undiagnosed, yielding devastating results.
I am not a physician, therefore the information on this page doesn't represent medical advice of any type, but it is my summation of what I learned during my mother's care.
My Mother's Diagnosis
As my mother's caregiver, I was taking her to an ophthalmologist to manage her glaucoma. She underwent a laser procedure that was successful in controlling the condition. During a routine visit a couple of months later to check on the status of the pressure in her eyes, she mentioned in passing that her head, and particularly, her left temple was extremely sensitive. It was so sensitive that at times it made it hard for her to lay on a pillow to sleep at night.
Her ophthalmologist was immediately concerned about temporal arteritis, also known as giant cell arteritis. He explained that this condition was an inflammation of the arteries, an inflammation that could potentially cause sudden and irreversible blindness, stroke, and so forth. Due to the possibility of such a negative outcome, he immediately prescribed prednisone to begin reducing the inflammation. He also ordered a blood test to see if there were any signs of inflammation in her temporal artery. If there was, my mother would need further testing to determine if she had TA.
The blood test examined her SED rate (also known as erythrocyte sedimentation rate/ESR) which is an indication of the degree of inflammation occurring in the body.
The results of her blood test indicated that there were signs of inflammation but a biopsy would provide more conclusive results by directly examining a section of the temporal artery. Within a week, she had the biopsy which was a quick and nearly painless procedure. Biopsy results indicated that there was evidence of arteritis and therefore, her regimen of prednisone was to continue. Because my mother also has osteoporosis, taking prednisone was a tricky matter as it can damage bones by blocking calcium.
Her regular physician then took over her care in regards to the arteritis. She then had to have periodic blood tests to assure her inflammation was being held in check as the doctor very gradually reduced the prednisone dosage.
Within a week or two, my mother no longer had pain in her temporal area. More importantly, she suffered none of the other more serious effects of this condition. However, it was to be nearly three more years before she was off of the medication.
Over the course of her treatment, her dose of prednisone was decreased each month. It didn't require a doctor's visit, just a quick trip for a blood test to check her SED rate. Then, if her inflammation was still low enough, the physician ordered a lower dose for the coming month. The dosage was decreased by 1mg each time.
My mother took calcium with vitamin D supplements and also received Reclast injections yearly in an effort to stop her bone loss. My understanding is that even for people without a degenerative bone disease, bone-saving treatments like these are sometimes recommended when initiating any corticosteroid treatment such as prednisone in order to help minimize the bone loss.
After 11 months, she was down to only a 5mg dose. In the intervening time, she had experienced a compression fracture as a result of her osteoporosis which was exacerbated by the prednisone. She underwent balloon kyphoplasty to maintain the affected vertebrae in an uncollapsed state. It was successful in this and in eliminating the associated pain.
Unfortunately, inflammation began to increase again at 11 months and her dose was increased back up to 20mg. After a couple of months, she was able to begin the gradual reduction in dosage once again. Overall, her treatment lasted nearly 3 years.
What Is Temporal Arteritis?
Temporal arteritis is an inflammation in the blood vessels, specifically those that supply your head with blood. It is sometimes called giant cell arteritis and can effect blood vessels elsewhere in the body. Due to the inflammation blood flow is reduced. This means that the areas supplied by the affected blood vessels can suffer damage.
What Causes Temporal Arteritis?
The cause of temporal arteritis isn't known. It is associated with a faulty immune response but researchers aren't sure what triggers it. It does happen much more frequently in women and does seem to run in families. Arteritis typcially occurs after age 50.
What Happens If You Have TA?
A number of symptoms may crop up if you have giant cell or temporal arteritis. However, the most severe outcomes include blindness, stroke (CVA), or an aortic aneurysm.
Blindness can occur very suddenly due to the restricted blood flow and is irreversible. A stroke can occur due to blood clots and result in death or permanent disability. If an aneurysm forms (a ballooning out of the vessel wall) it may burst, resulting in severe internal bleeding and potential death.
Clearly, anyone with temporal arteritis needs to be diagnosed quickly and receive treament to prevent any of these catastrophic events.
What Are the Symptoms?
There are many symptoms of temporal arteritis. For a comprehensive look at TA symptoms, you can refer to the John Hopkins Vasculitis Center website.
Some of the more common symptoms that my mother's physician discussed were jaw pain, loss of appetite, weight loss, headaches, scalp sensitivity, joint/stiffness, fatigue, double vision, and vision loss. My mother's medical history definitely included 6 of these 9 symptoms although it was not clear that they were all related to the temporal arteritis.
Diagnosing Temporal Arteritis
Obviously, the first step in diagnosing arteritis is for a physician to ask about related symptoms such as those mentioned above. After this, a blood test may be ordered. My understanding is that the blood test will not provide a definitive diagnosis but it can provide an indication that more testing (a biopsy) is warranted. The blood test can indicate only that there are signs of inflammation. (You can read more about the specifics of the blood test on the Mayo Clinic site.)
If the blood test indicates there are signs of inflammation, then a biopsy will be done. The biopsy will give the lab a chance to actually look at a section of the temporal artery. They can examine the cells under a microscope to see if they are normal or if "giant cells" are present.
The biopsy itself is pretty much painless. My mother's procedure was done with minimal sedation and was completed within 45 minutes to an hour. She had a small incision at her hairline on her left temple. It healed without a trace within a couple of weeks.
My understanding is that if "giant cells" aren't seen, it does NOT definitively mean that a person doesn't have arteritis. But if there are a significant number of "giant cells" seen the vessel, they can be pretty sure a person does have it. So the negative result isn't always "a clean bill of health".
From the literature I reviewed, it also seems that other procedures can be used to diagnose and monitor TA, but they were deemed unnecessary in my mother's case. Ultrasound, MRI, and PET scans can also be used to view blood flow.
The only treatment that I found mentioned in any of the literature I reviewed or which was mentioned by the three physicians we encountered, was that of prednisone to reduce the inflammation. Once inflammation is reduced normal blood flow is possible.
I don't know the rate of success, but it seems to be universally accepted that if the appropriate dosage is given, the problem can be controlled. I know in my mother's case, the dosage has been kept low based on her osteoporosis and the risk of further bone damage due to the treatment. Apparently, patients have to be slowly "weaned" off of the prednisone, as stopping it abruptly can cause serious, even life-threatening problems. It may be necessary to take medication for two, three, or even up to five years to avoid relapses.
It's frustrating, but it appears that the treatment for temporal arteritis (corticosteroids such as prednisone) may be harmful in a number of instances. However, the risks that exist if the arteritis is left untreated are too great to avoid the treatment. However, you can learn more about the potential side effects of prednisone on the Geriatric Medicine site.
Due to the risks of using these medications, there are additional treatments a physician may prescribe to help reduce the potential side effects. Diet changes, dietary supplements, exercise programs, medications to preserve bone, blood pressure medications, aspirin, and so forth are examples.
Additional Precautions When Taking Prednisone
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2018 Christine Mulberry