Temporal arteritis
Giant
The temporal arteritis is a vasculitis in the head arteries.
The emergence of temporal arteritis is still unknown. Suspected a connection with a viral infection. This is indicated a seasonal increase of the disease, the increased indication of previous infection (influenza, pneumonia healthy) in the comparison. Several studies report on possible links with genetic predispositions.
Pathogenetically a cell-mediated autoimmunity is a granulomatous inflammation of the carotid vessels in favor of the outgoing temporal artery.
Frequency
Temporal arteritis affects primarily persons> 50 years. Women are affected more often than men. There is a strong north-south gradient of disease incidence. In Scandinavian countries, the incidence of disease with 29 patients per 100,000 inhabitants> 50 years at the highest.
Symptoms
- The temporal arteritis is associated with opschmerzen, especially in the temporal, fatigue, weight loss, fever and depression. The temporal artery (temporal artery) is often thickened, palpable tenderness and sometimes no pulse. When including the central retinal artery (eye / retinal artery) are vision problems including blindness.
- Often the temporal arteritis occurs together with polymyalgia rheumatica. The Coinzidenz these two diseases is different in different ethnic groups. It is highest in the Scandinavian countries. In Norway, about 80% of all patients suffering from polymyalgia rheumatica also affected by a temporal arteritis.
- In the presence of polymyalgia rheumaticabestehen as additional symptoms of morning stiffness and pain in the shoulder and lap belts with tenderness of the upper arms.
Diagnosis
The diagnosis of temporal arteritis is based on the characteristic symptoms. In eyes seek medical study shows by participating in the eyes / Netzhauarterie a cherry spot in the fovea centralis (central fovea). The ultrasound (Doppler) scan of the temporal artery shows a Flow reduction and to support the diagnosis can be used. If a tissue of the artery is examined to find the so-called "giant cells" that are typical of the disease. The blood sedimentation rate is almost always significantly increased (more than 50 mm in the first hour).
Therapy
- The diagnosis of temporal arteritis requires immediate treatment to prevent complications such as blindness. The first-choice are corticosteroids. After initially higher dose can be reduced to this after a few months to a so-called maintenance dose. This maintenance dose is administered nichzt rarely over 5 years to prevent a recurrence.
- Other immunosuppressive agents were also used for the treatment of temporal arteritis. To name are methotrexate and azathioprine. They can also be used for saving of corticosteroids. On the use of cyclosporin A, there is little literature.