Temporal artery inflammation symptoms treatment. What is temporal arteritis. Description of inflammation of the temporal artery

Arteritis is the general name for a whole group of diseases caused by immunopathological inflammatory processes occurring in blood vessels. Inflammation leads to narrowing of the vascular lumen, obstruction of blood flow and the formation of favorable conditions for thrombus formation. Disruption of the blood supply to organs and tissues ends in ischemia and the development of serious diseases. All vessels are subject to inflammation: arteries, veins and capillaries. The disease brings many problems and troubles to patients.

Arteritis has several names - angiitis, Horton's disease, temporal arteritis. All these terms refer to the same pathology - inflammation of the vascular wall.

Arteritis is of origin:

Primary, arising as an independent nosological unit - giant cell arteritis;
Secondary, resulting from other pathologies.

According to the nature of inflammation, arteritis is divided into specific and nonspecific, according to the type of pathological process - purulent, necrotic, productive and mixed; according to the localization of the lesion in the vessel wall - endoarteritis, mesoarteritis, periarteritis, panarteritis. Often inflammation of the vascular wall is combined with thrombosis. This condition is called thrombarteritis.

The disease usually develops in older people aged 50-70 years. In younger people, pathology occurs only in exceptional cases. Horton's syndrome is a disease of old people, but there may be rare exceptions to any rule. According to statistics, it develops more often in men aged 20-30 years, in children under 5 years of age, inflammation of large arteries – in women of reproductive age.

Etiology

The causes of giant cell arteritis currently remain unknown. The pathology is based on autoimmune inflammation. Age-related changes that occur in the walls of blood vessels lead to a loss of their elasticity, which further aggravates the situation and contributes to the development of the disease.

There are several theories for the development of arteritis:

Hereditary predisposition - this disease is often found in members of the same family and almost always in identical twins.
Infectious theory - the presence of antibodies and antigens in the blood of people who have had influenza, staphylococcal infection, or hepatitis.
Autoimmune theory, according to which Horton's syndrome is classified as collagenosis. Foreign formations provoke the production of antibodies that attack the vessel’s own tissues. In some patients with arteritis, the same signs of damage to the connective tissue and blood vessels were revealed as in periarteritis nodosa. Arteritis often occurs in patients with dermatomyositis and scleroderma.

Temporal arteritis primarily affects large blood vessels, affecting the capillaries only in rare cases. Inflammation of the vascular wall leads to disruption of tissue structures, narrowing of the lumen of the vessel, organ ischemia, deterioration of local blood flow, and the formation of a blood clot that completely blocks the lumen. Thinned and stretched walls of arteries or veins protrude, an arterial aneurysm develops, which, against the background of a sharp increase in blood pressure, can rupture.

The clinical picture of the disease is determined by the localization of the lesion. Patients develop acute cerebrovascular accident, loss of vision, and stroke. Typically, inflammation occurs in the carotid arteries, aorta and other vascular structures that supply blood to areas of the head and cerebral cortex, the optic nerve, the organ of vision, and some internal organs.

artery changes in giant cell arteritis

Inflammation in arteritis is focal or segmental in nature: vessels are not affected along their entire length, but in individual areas or segments. The elastic membrane is infiltrated by lymphocytes, the intima thickens, plasma cells, epithelial cells, histiocytes, and multinucleated cells accumulate in it, forming extensive granulomas. Multinucleated giant cells are complexes circulating in the blood that give the disease its name.

In the blood of patients with exacerbation of arteritis, a large number of immune complexes, lymphoblasts, and serum immunoglobulins are found.

Video: temporal arteritis – medical animation

Symptoms

General symptoms of pathology that precede the appearance of specific symptoms:

Fever,
Weakness,
Lack of appetite,
Hyperhidrosis,
Myalgia,
Noticeable weight loss.

With arteritis, the temporal artery becomes inflamed in 90% of cases, and temporal arteritis develops. Patients complain of constant headaches of varying degrees of intensity. The temporal arteries swell, swell, pulsation weakens, and they become painful. When arterial blood vessels supplying the brain are damaged, corresponding symptoms appear.

visible manifestations of temporal arteritis

Headache occurs in 70% of patients with arteritis. This is the first symptom of the disease, which is diffuse in nature. When palpating these arteries, the pain becomes diffuse and unbearable. Inflamed vessels thicken and become tortuous, the skin over them turns red and swells. Temporal arteritis is manifested by pain in the temples, radiating to the neck, lower jaw, and shoulder. The pain is severe, throbbing, aggravated by palpation and chewing. Vision is impaired, eyelid drooping, double vision and pain in the eyes are observed. In the arteries of the neck and upper extremities, the filling and pulse rate change: it first weakens and then disappears completely. The muscles of the limbs weaken, polymyalgia develops - a special form of pathology, manifested by pain and stiffness in the muscles of the shoulder, pelvis, arms and legs.

For inflammation of the maxillary and facial arteries soreness and numbness of the masticatory muscles, tongue damage, and toothache appear. Burning pain under the jaw reaches the upper lip, nose and corners of the eyes. These signs are caused by insufficient blood supply to the corresponding muscles.

The disease affects the blood vessels supplying the organs of vision. In patients, the optic nerve, choroid, iris, conjunctiva, sclera become inflamed, diplopia and drooping of the upper eyelid develop. These symptoms may be temporary or persistent. Inflammation of the branches of the ophthalmic and ciliary arteries leads to their thrombosis, optic nerve ischemia and blindness.

One of the most common forms of arteritis is polyarteritis nodosa.. This is a pathology of the lower extremities that develops in people leading a sedentary lifestyle and in long-term smokers. Patients experience causeless fever, sudden weight loss, severe pain in the muscles and joints of the legs. On palpation, areas of compaction and nodules are detected. These are arterial aneurysms.

Diagnostics

The diagnosis and treatment of arteritis is carried out by rheumatologists with the involvement of specialists from other medical specialties - nephrologists, dermatologists, hematologists, cardiologists, neurologists, psychiatrists. It is quite difficult to identify pathology and make a correct diagnosis in the initial stages.

The main diagnostic methods to detect arteritis:

Conversation with the patient
General examination of the patient, pulse measurement, auscultation of the heart and lungs,
General and biochemical blood test - increased ESR and C-reactive protein, moderate anemia,
Ultrasound of blood vessels,
Artery biopsy - identification of multinucleated giant cells,
Arteriography,
Fundus examination,
Ophthalmoscopy - detection of ischemic neuritis of the optic nerve.

Treatment

The pathology is based on a powerful inflammatory process, which only corticosteroids can cope with. They suppress inflammation within the arteries, while at the same time being a reliable prophylactic agent. Patients are prescribed high doses of corticosteroids for oral or parenteral administration - “Decortin”, “Prednisolone”, “Medopred”, “Prednisol”. Tablets are taken 3 times a day, mainly after meals.

The duration of treatment with Prednisolone ranges from 12-24 months. Prednisolone is by far the most effective remedy in the treatment of arteritis. In almost all patients, it gives a clear therapeutic effect: body temperature normalizes, symptoms of intoxication and asthenia disappear, and ESR decreases. Glucocorticoid drugs have a number of side effects, including hyperhidrosis, the appearance of hematomas, swelling of the face, weight gain, osteoporosis in the elderly, and psycho-emotional breakdowns.

Persons who do not tolerate glucocorticoids well are treated with Methotrexate, Azathioprine and other drugs of this group.

To improve the rheological properties of blood and its physical state, Aspirin, Dipyridamole, Curantil and other angioprotectors are prescribed. They restore blood microcirculation in the affected artery, reduce the risk of hypercoagulation, and eliminate vasoconstriction.

To prevent blood clots and optimization of blood flow, heparin therapy is carried out. Treatment with Heparin lasts five to six days, after which they proceed to the use of indirect anticoagulants, for example, Warfirin.

If infectious factors play a role in the development of arteritis, patients are prescribed antibacterial or antiviral drugs - Ceftriaxone, Ofloxacin, Clindomycin, Interferon, Ingavirin.

With the development of such complications of arteritis as thrombosis of a vessel, oncopathology, or the formation of an aneurysm, surgical intervention is required. In such cases, angioprosthesis or bypass surgery is performed. During the operation, the affected areas of the vascular bed are removed, restoring vascular patency.

ethnoscience

It should be remembered that traditional medicine only relieves pain for a short time and reduces the intensity of other signs of inflammation. They fail to deal with the source of the problem. This is just an “ambulance” to alleviate the condition and relieve discomfort. If the symptoms listed above appear, you should consult a doctor and undergo a full examination.

To relieve headaches, decoctions and infusions of medicinal herbs are used:

With timely consultation with a specialist and adequate therapy, the prognosis of the disease is quite favorable. Minimal pathological changes occur in the body, allowing patients to live a full and normal life.

Patients who ignore constant headaches risk becoming disabled. Advanced forms of arteritis lead to unfavorable and quite serious complications that are difficult to treat and continue to progress.

Video: temporal arteritis in the program “Live Healthy!”

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Temporal arteritis is a systemic lesion of medium-sized arterial vessels. The inflammatory process primarily involves the carotid artery and its branches. Most often, the superficial temporal artery is susceptible to pathological changes, the specific granulomatous lesion of which gives the name to the disease. But this term is not the only one. This pathology is also known as Horton's disease or giant cell mesarteritis.

Causes

Not a single theory of the origin of the disease has been reliably confirmed. Presumably, the infectious factor plays an important role in its development. There is often a natural connection between the occurrence of arteritis and previous influenza and group B hepatitis. The genetic programming of pathology also has its supporters. Cases of this rather rare disease have been observed in close relatives and identical twins.

The leading role in the formation of inflammation of the vascular wall belongs to immunological disorders, and this is recognized by adherents of all etiological concepts. With temporal arteritis, the immune system reacts inadequately to its own tissues - the process proceeds as an autoimmune one.

Symptoms

The disease has no characteristic onset. Several options are possible: acute, subacute, but more often with a long period of precursors, which can last several weeks or more than one month.

A set of symptoms preceding the height of the disease and united by a common name polymyalgia rheumatica, includes the following manifestations:

General malaise;

Slight increase in body temperature within 37.2–37.5°C;

Excessive sweating, especially at night;

Aches in the joints;

Pain in the muscles;

Sleep disorders;

Loss of body weight.

Later, vascular disorders come to the fore; their nature and severity depend on the location and degree of damage to the artery. More than half of patients suffer from vision impairment. Patients note:

Headache of varying intensity, often sudden, in various areas (temporal, frontal, parietal, less often - occipital);

Hyperesthesia (increased sensitivity) of the scalp, making it difficult to comb or wear a hat;

Transient pain and numbness in the tongue and lower jaw, which intensifies when talking and chewing;

Painful, stringy compaction along the inflamed artery;

Visual impairment (decreased visual acuity, diplopia (double image), blindness);

Neurological, mental disorders.

When the aorta, coronary, renal, and mesenteric arteries are involved in the pathological process, which happens in severe untreated variants of the disease, the development of aneurysm, angina pectoris and heart attack, impaired blood supply and kidney and intestinal function are possible.

Diagnostics

The diagnosis of arteritis can be established by performing histological examination section of the superficial temporal artery obtained by biopsy. The sample collection is carried out under local anesthesia and is not difficult. The detection of granulomatous inflammation of the vascular wall with the presence of giant cells is indisputable evidence of this pathology.

But histologists are able to identify typical changes only in half of the cases. The fragmentary nature of the lesion does not always allow for successful selection of the segment for biopsy. However, a negative result does not mean the absence of the disease, since the main criterion for diagnosing Horton’s disease is the totality of clinical manifestations.

Criteria have been formulated and generally accepted to recognize temporal arteritis. The diagnosis is reliable if three or more of the following factors are present:

Age over 50 years;

Headaches with severe intensity;

Vision problems;

The presence of complaints characteristic of polymyalgia rheumatica;

Decrease in the number of red blood cells and hemoglobin level in the blood, increase in ESR.

Sphygmography, rheovasography, and Dopplerography of the affected arteries are of auxiliary value for differential diagnosis. For the same purpose, the presence of C-reactive protein and the level of sialic acid and fibrinogen in the blood are determined.

Treatment

At the moment, there are two directions in the treatment of temporal arteritis: therapeutic and surgical. Surgical methods are resorted to in the event of the development of complications such as aortic aneurysm and thrombosis of blood vessels, especially those supplying blood to the eyeball.

The basis of disease therapy, without which it is impossible to achieve positive results, is the prescription steroid hormones(prednisolone). There is no alternative to glucocorticoids. They are prescribed as early as possible and taken for a long time. Doses and regimen are selected individually, under constant laboratory monitoring of clinical and biochemical blood parameters. A combination of hormones and drugs that suppress immune responses is possible. Symptomatic treatment is also carried out using anticoagulants, agents that improve microcirculation, and vitamins.

Forecast

Temporal arteritis is a serious disease. If not recognized in a timely manner and treated inadequately, the pathology poses a threat to the health and life of the patient. A timely diagnosis and compliance with doctors’ recommendations avoid complications and make the prognosis favorable.

In our department of vascular surgery, a full examination, qualified interpretation of the results obtained and professional implementation of all types of treatment measures are possible.

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Causes

The exact causes of Horton's disease are unknown. It is only known that the disease develops against the background of impaired immune reactions in the form of autoimmune processes, most often affecting women aged 70-80 years. This is proven by the fact that more than 50% of patients have antibodies to immunoglobulin types M and A, as well as deposits of immune complexes on the affected arteries.

Scientists agree that factors that increase the likelihood of temporal arteritis include:

predisposition;
infectious agents, mostly hepatitis, influenza and herpes viruses;

This is dictated by the fact that 33% of patients had Hbs antigen and antibodies to it. The predisposition is evidenced by the fact that many patients have the HLA genes B14, A10, B8.

The following video will tell you why temporal arteritis is terrible:

Symptoms of Horton's disease

In the early stages, temporal arteritis may have no symptoms. On the other hand, if the patient has previously suffered an infectious disease, temporal arteritis may have an acute onset, which is due to reduced immunity.

Initially, the disease has symptoms of ARVI: fever, pain in the head, fatigue. Later, weight loss up to anorexia, myalgia and arthralgia, as well as insomnia are added to them.

As Horton's disease progresses, it acquires vascular symptoms. For example:

increased density of the temporal arteries;
their soreness that occurs when palpated;
nodules on the scalp;
swelling and hyperemia of the skin in the temple area;

The disease is also accompanied by damage to the organs of vision:

diplopia (double vision);
blurring of surrounding objects;
blurred vision;
pain;

Symptoms are associated with vascular lesions and impaired blood supply to the eyeballs. If, after identifying the symptoms, you do not begin treatment for temporal arteritis, the disease can lead to complete loss of vision.

The following video will tell you more about the symptoms of Horton's disease and methods for relieving them:

Diagnostics

Making a diagnosis begins with a visit to the doctor. The doctor collects anamnesis, compares the patient’s signs with the clinical picture of arteritis, and then prescribes additional studies:

Examination by an ophthalmologist and neurologist.
Temporal artery biopsy.
Clinical blood test showing the presence of anemia and leukocytosis.
Biochemical analysis of blood, revealing dysproteinemia.
Ultrasound examination of extracranial vessels.
MRI and CT.
Angiography.

There is a diagnostic table compiled by the Association of Rheumatologists, which contains the following criteria:

patient over 50 years old;
presence of headache;
pathology of the temporal artery;
ESR above 50 mm/h;

If at least 3 criteria coincide, then we can already talk about the presence of Horton’s disease, the treatment of which we will discuss later.

Treatment

Treatment of temporal arteritis can be therapeutic or surgical. To understand who treats temporal arteritis, when and what treatment can be prescribed, let’s take a closer look at each.

In a therapeutic way

In fact, this is the only effective treatment that specifically targets temporal arteritis. The therapeutic method consists of hormonal therapy. It is carried out with prednisolone or methylprednisolone according to the following scenario:

Prednisolone is taken 60 milligrams per day for 2-4 days. Every week the dosage is reduced by 5 mg, bringing it to 40 mg/day. After this, the dosage is reduced by 2 mg weekly up to 20 mg/day. Afterwards, the dose is reduced by 1 mg weekly. If the disease worsens, the dosage of the medication is temporarily increased until the symptoms disappear completely.
Methylprednisolone is taken by pulse therapy, 1 g intravenously for 3 days. Afterwards, methylprednisolone is taken orally 20-30 mg per day.

If the patient cannot take the above medications, or they do not help, the doctor may prescribe cytostatics, for example, azathioprine, methotrexate and others.

Surgical method

Surgery is prescribed only when arteritis develops complicated or against the background of cancer, blood clots or aneurysms. At the same time, the arteritis itself is not affected, so in each case such treatment is individual.

We will talk further about whether it is possible to treat temporal arteritis with folk remedies.

Folk remedies

Doctors strictly warn that treatment with folk remedies can negatively affect the patient’s health. Since the disease progresses, and treatment with alternative medicine cannot affect it, the condition can develop into serious complications.

However, folk remedies can have a positive effect on the patient’s immunity, as well as relieve negative symptoms. Along with therapeutic treatment, you can take decoctions of medicinal herbs and tinctures, do massages, acupuncture and undergo similar procedures.

Prevention of disease

Since the causes of the disease are poorly understood, doctors cannot give precise recommendations on preventive measures. However, since there is a connection with viral diseases, it is worth paying more attention to immunity, namely:

normalize the daily routine;
eat a balanced diet;
take multivitamins;
at the slightest sign of temporal arteritis, consult a doctor;

Complications

The most serious complications of arteritis are blindness and heart attacks, right-sided amaurosis and aneurysm of the aortic arch. These conditions occur if the disease is started.

Complications can appear during hormonal therapy, usually in the form of decreased immunity, headaches and individual symptoms.

Photo of Horton's disease (temporal arteritis)

Forecast

The prognosis for treatment of the disease is positive. With timely treatment, more than 80% of patients are cured.

On average, the disease lasts 2–4 years. Despite positive treatment, the disease is often accompanied by complications.

gidmed.com

Temporal arteritis and everything you need to know about it

Temporal arteritis – what is it and what does it mean?

Temporal arteritis (giant cell arteritis, Horton's disease) is an inflammatory disease of the medium and large arteries. In general, all arteries of the body are susceptible to inflammation, but most often the disease affects the arteries of the head and neck. It is precisely this localization of foci of inflammation that makes the disease very dangerous, because its complications include impaired blood flow, partial or complete blindness, and even stroke.

In addition, a characteristic feature of the disease is the formation of granulomas on the walls of blood vessels, which can consequently lead to blockage of the lumens of the arteries and thrombosis.

People aged 50-70 years most often suffer from this disease.

Most often, the disease develops after 50 years of age, and its peak occurs at the age of 70 years or more. It is noteworthy that women predominate in the risk group - according to statistics, they suffer from arteritis 3 times more often than men.

But, fortunately, temporal arteritis is now successfully treated, which distinguishes it from other inflammatory diseases of the body. And, nevertheless, having at least a superficial knowledge of the causes, symptoms, methods of diagnosing and treating arteritis is sometimes vital.

Causes of temporal arteritis

To date, the exact causes of temporal arteritis are unknown. However, it has been established that the natural processes of aging of blood vessels and the concomitant destruction of their walls, as well as genetic predisposition, will play an important role in the development of the disease.

In addition, in some cases, the impetus for the development of temporal arteritis may be severe infectious diseases, the treatment of which was accompanied by the use of strong antibiotics. In addition, inflammation can be triggered by certain viruses, which, when entering the body, affect the walls of weakened arteries.

Temporal arteritis - main symptoms

The first alarming symptom that cannot be ignored is the sudden onset of sharp pain in the temples and radiating pain in the tongue, neck and even shoulders.

Throbbing pain in the temples may be the first symptom of temporal arthritis.

A clear sign of developing temporal arteritis is throbbing pain in the temples. Moreover, simultaneously with the pain symptom, a pronounced pulsation of the temporal artery can be felt upon palpation.

Very often, attacks of pain are accompanied by partial or complete loss of vision, which can last from several minutes to many hours. In this case, we are talking about progressive inflammation of the arteries and damage to the eye vessels.

In addition, secondary symptoms may indicate inflammation of the temporal arteries, among which the following are worth noting:

Temporal arteritis (giant cell arteritis)

Temporal arteritis, also known as giant cell arteritis, is an inflammatory disease of the medium-sized arteries that supply the head, eyes, and optic nerves. Place your fingers firmly against your temple and you will feel a very pronounced pulsation. This is the temporal artery pulsating. The disease usually affects people over 60 years of age and is manifested by swelling and tenderness of the vessels of the temple and scalp. Women suffer from this disease 4 times more often than men.

The main danger of temporal arteritis is loss of vision, although with a long course of the disease, other arteries are also involved in the process. This disease is potentially dangerous for vision, but with proper treatment started in a timely manner, this can be avoided. The danger is that blood flows poorly to the eyes and optic nerves through the inflamed arteries, so without treatment, the nerve cells of the retina and optic nerve die.

Signs (symptoms)

Patients with temporal arteritis usually begin to complain of vision in one eye, but half of them notice symptoms in the fellow eye after a few days without treatment.

Headache

Pain in the scalp when touched (for example, scratching)

Temple pain (can be unbearable)

Temporal (giant cell) arteritis is a rather rare systemic vascular disease, the main manifestations of which are signs of damage to the vessels of the external and internal carotid arteries and, very rarely, arterial trunks extending directly from the aortic arch.

In the vast majority of cases, this disease is detected in patients of fairly advanced age (only isolated cases of the disease are diagnosed in persons under 50 years of age). When studying the characteristics of temporal arteritis, it was found that very often the symptoms of this disease occur together with manifestations of polymyalgia rheumatica. Most often, the first manifestations of the disease are found in women aged 60-70 years.

Causes of temporal arteritis

Despite numerous studies that have been conducted since the first description of the manifestations of temporal arteritis by American rheumatologists Horton, Magath and Brown in 1932, they have not been reliably established. It is generally accepted that some time before the first signs of the disease appeared, the patient could come into contact with various viruses, bacteria, including Mycobacterium tuberculosis. The possible influence of heredity is also not denied - in those areas of the globe where the population has entered into consanguineous marriages for a long time, the number of cases is significantly higher than in the population as a whole (the largest number of cases were identified in the Scandinavian countries of Europe and the northern states of the USA).

The influence of environmental factors, under the influence of which disturbances in the activity of the patient’s immune system develop, is also considered proven - increased sensitivity (sensitization) of the body becomes a trigger point in the development of the autoimmune process.

Its main foci are concentrated in the vascular wall of medium- and small-caliber arteries. As a result of these processes, normal blood flow is hampered, and the phenomena of degeneration and ischemia develop in the tissues that are located behind the site of vessel damage.

Most often, the inflammatory process in the vascular wall with giant cell arteritis affects the arteries of the head, but in exceptional cases, with rapid progression of inflammation, damage to the coronary arteries, kidney vessels, and intestines is possible - parietal blood clots can form in them, causing a progressive narrowing of the lumen of the blood vessel.

Symptoms of temporal arteritis

In the vast majority of cases, the development of severe inflammation of the arteries is preceded by a fairly long prodromal period (the stage of precursors of the disease), which specialists - rheumatologists and angiologists call polymyalgia rheumatica. It is characterized by severe general weakness, deterioration of health, and the appearance of constant low-grade fever (the temperature does not rise above 37.70 C), which is often accompanied by sweating in the evening and at night. During the same period, unpleasant sensations or pain may occur in the muscles and joints of the whole body, causing insomnia for patients, and with the addition of nausea and lack of appetite, the patient’s weight loss quickly begins to progress. The duration of the prodromal stage can vary from several weeks to several months, and an inverse relationship has been reliably established between the duration and severity of the symptoms of polymyalgia rheumatica and the severity of temporal arteritis itself (the shorter the precursor stage, the more severe the vascular damage itself).

The most characteristic and subjectively difficult to tolerate symptom is headache. Most often it is concentrated in the temporal region, but can spread to the frontal and parietal zones, and very rarely to the back of the head. The pain can be aching or throbbing, and it almost always occurs spontaneously - the patient does not feel the warning signs of an attack (unlike migraine). Unpleasant sensations in the vast majority of cases intensify at night, quickly become unbearable, and within a few hours after the onset of the attack, you can see the scalp being thick and inflamed, sharply painful when trying to palpate the cord - the affected artery.

In cases where the process affects the arteries supplying blood to the facial area, the patient may experience “intermittent claudication” of the tongue, chewing and, very rarely, facial muscles; this significantly complicates the patient’s normal communication (difficulties arise when speaking) and nutrition (prolonged chewing food causes sharp pain in the facial muscles).

In approximately half of the patients, in the absence of adequate treatment, temporal arteritis begins to rapidly progress, and after 30-40 days, visual impairment may appear; the cause of the development of arteritis is ischemic damage to the optic nerve or thrombosis of the central retinal artery. In this case, there is a high probability of irreversible blindness - the cause of its early development is atrophy of the optic nerve.

When the main arteries are involved in the process, changes develop, the area of distribution of which coincides with the areas of blood supply. That is why, when the cerebral arteries are involved in the process, signs of acute cerebrovascular accident or dyscirculatory encephalopathy with a predominance of mental disorders may appear. With changes in the coronary arteries, the appearance of angina pectoris and its subsequent progression to myocardial infarction is inevitable; if the aorta is damaged, a characteristic clinical picture of an aneurysm of its arch appears; if the arteries of the kidneys or intestines are damaged, chronic renal failure or attacks of “abdominal toad” develop, respectively.

Diagnosis of the disease

To establish or confirm the diagnosis, it is necessary to perform a clinical analysis of blood and urine, the changes of which are similar to the manifestations of other autoimmune diseases - anemia, a sharp increase in ESR, and traces of protein in the urine are detected. A biochemical blood test reveals signs of an active inflammatory process and changes in the coagulogram. An accurate diagnosis can be made only after a histological examination of a piece of the wall of the temporal artery obtained by performing a percutaneous biopsy.

Treatment of temporal arteritis

Effective treatment of temporal arteritis is impossible without the prescription of glucocorticoid (steroid) hormones, which are used first in an overwhelming dose, and then the daily amount of the drug is very slowly and gradually reduced.

In some cases, it is also necessary to prescribe immunosuppressants - these drugs are needed when there is a threat of developing blindness or when signs of generalization of the process are identified (without treatment, patients in this case rarely survive more than 6 months). It is important to remember that with temporal arteritis, a reliable indicator of improvement is not a change in the patient’s well-being, but the dynamics of laboratory parameters, therefore the dose of hormones is selected based on the severity of nonspecific laboratory parameters of inflammation (ESR, C-reactive protein).

In addition, in case of severe disorders of blood clotting processes, direct and indirect anticoagulants and antiplatelet drugs are prescribed. To improve the general condition of the patient, symptomatic (eliminating individual manifestations of the disease) and metabolic therapy are prescribed - antianginal drugs for angina pectoris and abdominal pain, vitamins.

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Etiology

The causes of giant cell arteritis currently remain unknown. The pathology is based on autoimmune inflammation. Age-related changes that occur in the walls of blood vessels lead to a loss of their elasticity, which further aggravates the situation and contributes to the development of the disease.

There are several theories for the development of arteritis:

Hereditary predisposition - this disease is often found in members of the same family and almost always in identical twins.
Infectious theory - the presence of antibodies and antigens in the blood of people who have had influenza, staphylococcal infection, or hepatitis.
Autoimmune theory, according to which Horton's syndrome is classified as collagenosis. Foreign formations provoke the production of antibodies that attack the vessel’s own tissues. In some patients with arteritis, the same signs of damage to the connective tissue and blood vessels were revealed as in periarteritis nodosa. Arteritis often occurs in patients with systemic lupus erythematosus, dermatomyositis, and scleroderma.

In the blood of patients with exacerbation of arteritis, a large number of immune complexes, lymphoblasts, and serum immunoglobulins are found.

Video: temporal arteritis - medical animation

Symptoms

General symptoms of pathology that precede the appearance of specific symptoms:

Fever,
Weakness,
Lack of appetite,
Hyperhidrosis,
Myalgia,
Noticeable weight loss.

Diagnostics

The main diagnostic methods to detect arteritis:

Conversation with the patient
General examination of the patient, pulse measurement, auscultation of the heart and lungs,
General and biochemical blood test - increased ESR and C-reactive protein, moderate anemia,
Ultrasound of blood vessels,
Artery biopsy - identification of multinucleated giant cells,
Arteriography,
Fundus examination,
Ophthalmoscopy - detection of ischemic neuritis of the optic nerve.

Treatment

The duration of treatment with Prednisolone ranges from 12-24 months. Prednisolone is by far the most effective treatment for arteritis. In almost all patients, it gives a clear therapeutic effect: body temperature normalizes, symptoms of intoxication and asthenia disappear, and ESR decreases. Glucocorticoid drugs have a number of side effects, including hyperhidrosis, the appearance of hematomas, swelling of the face, weight gain, osteoporosis in the elderly, and psycho-emotional breakdowns.

Persons who do not tolerate glucocorticoids well are treated with Methotrexate, Azathioprine and other drugs of this group.

If infectious factors play a role in the development of arteritis, patients are prescribed antibacterial or antiviral drugs - Ceftriaxone, Ofloxacin, Clindomycin, Interferon, Ingavirin.

ethnoscience

It should be remembered that traditional medicine only relieves pain for a short time and reduces the intensity of other signs of inflammation. They don't deal with the source of the problem. This is just an “ambulance” to alleviate the condition and relieve discomfort. If the symptoms listed above appear, you should consult a doctor and undergo a full examination.

To relieve headaches, decoctions and infusions of medicinal herbs are used:

With timely consultation with a specialist and adequate therapy, the prognosis of the disease is quite favorable. Minimal pathological changes occur in the body, allowing patients to live a full and normal life.

Patients who ignore constant headaches risk becoming disabled. Advanced forms of arteritis lead to unfavorable and quite serious complications that are difficult to treat and continue to progress.

Blood vessels are certain channels, unique pathways through which the body receives the necessary nutrients and atomic oxygen, releasing waste and simply harmful substances into the environment in return. Unfortunately, blood vessels, like other organs, are susceptible to various diseases, for example, one of the most typical angiitis is temporal arteritis in young and elderly people.

One of the common vascular diseases caused by a wide variety of factors (pathogenic pathogens, age-related tissue changes, hereditary tendency, aggressive external environment, autoimmune reactions, etc.) are arteritis (angiitis), which is.

Temporal arteritis has other names - Horton's disease/syndrome, or giant cell, temporal arteritis (according to ICD-10, represented by M31.6.)

The disease was first officially noted in 1890, and in 1932 the symptoms were described by the American physician W. Horton.

Temporal arteritis is a systemic vascular disease, expressed in a massive inflammatory process of all arteries, and the affected cells accumulate in their walls in the form of so-called “granulomas”, and blood clots also form. As a result, disrupting its functionality.

Causes

The causes of temporal arteritis in young people are different. Like other angitis, it occurs both as an independent pathological process (primary arteritis), the causes of which have not been thoroughly determined by science (versions of its occurrence from an infectious factor to a hereditary predisposition), and in the form of a concomitant disease (most often accompanies a disease such as rheumatic fever). polymyalgia), as well as as a consequence of other pathological conditions, the so-called secondary arteritis.

In addition, the cause of secondary temporal arteritis is advanced age and nervous overload, causing a decline in immunity. Also, many experts consider taking large doses of antibiotics to be a provoking agent.

The disease is quite common, affecting on average 19 people out of one hundred thousand.

Pathogenesis

Horton's disease belongs to the so-called systemic vasculitis, with a characteristic lesion of all large (6-8 mm in diameter) and less often medium arteries. In this case, the arteries of the upper half of the body most often become inflamed - the head, shoulders, arms, arteries of the eyes, vertebral arteries, and even the aorta.

Patients diagnosed with temporal arteritis are predominantly elderly people over 59 years of age. Particularly widespread is observed among people over 71 years of age. It is noteworthy that there are approximately four times more women among the cases than men.

The temporal artery is not difficult to detect: it is enough to touch your temple with your fingertips with slight pressure to feel the moderate pulsation of the vessel. Affected by this disease, the artery causes severe swelling of the temple itself and scalp. The tissue around the inflamed vessel is reddened.

At the initial stages, immune inflammation of the vascular walls of the arteries is observed, since the formation of autoantibody complexes begins in the blood, which attach to the inner surface of the vessels

The process is accompanied by the release of so-called inflammatory mediators by the affected cells, which spread from the inflamed vessel to adjacent tissues.

Temporal arteritis, unlike all other inflammations of the arteries, is quite treatable. The main thing is to diagnose the disease in the early stages and provide adequate therapy.

The symptoms of temporal arteritis are quite typical.

When first seeing such a patient, the doctor should be alert to the following characteristic manifestations of temporal arteritis:

hyperemia of facial tissues, pronounced prominence of facial vessels;
complaints about a local increase in temperature;
sharp, throbbing, often difficult to bear pain in the affected temple, radiating to the neck and back of the head.
In addition, due to inflammation of the tissues adjacent to the vessel, the patient experiences drooping of the upper eyelid of the affected side of the face.
Such patients see objects blurry, not clearly, complain of double vision, decreased visual acuity of one (over time, without treatment, the second eye is affected). Deterioration of vision can be temporary, transient. The patient complains of headache, general weakness and bad mood.
When eating food, there is pain in the jaw. Also noticeable is increased, abnormal pain when touching or scratching the scalp, depression and loss of strength (asthenia).

Diagnostics

Temporal arteritis, not detected in the early stages, develops, threatening to become chronic. This can lead to complete loss of vision due to severe disruption of the blood flow supplying the optic nerve. This is why early diagnosis of temporal arteritis is extremely important.

In addition to the initial history taking, the cardiologist performs the following actions:

general examination, including palpation of the external blood vessels to detect their tenderness. On examination, the temporal artery may be thickened and hard to the touch. The pulse in the area of inflammation is weak or not felt at all;
eye pressure and body temperature are measured.
using medical devices, auscultation of internal organs (lungs and heart) is performed;
An ultrasound examination of blood vessels is performed;
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The patient's blood is examined in the laboratory (general and biochemical tests). Temporal arteritis is characterized by anemia. Moreover, in analyzes it is observed that it reaches 101 mm in 1 hour. In addition, the volume of C-reactive protein synthesized in liver cells and entering the blood during injury and inflammation has been significantly increased.

It happens that all of the above methods still do not allow us to make a confident diagnosis. Then they resort to a biopsy of the affected vessel. The procedure is performed under local, local anesthesia. A small fragment of an organ is taken to examine it microscopically for the presence of affected cells. A biopsy allows you to diagnose the disease with one hundred percent certainty.

Other medical specialists are also involved (primarily an ophthalmologist).

Since temporal arteritis in young people can lead to severe, irreversible consequences (stroke due to inflammation of the arteries of the vestibular zone, heart attack, blindness, etc.), even death, treatment of temporal arteritis must be started based on the symptoms that appear.

The treating specialists are usually cardiologists, surgeons and phlebologists.

Basically, such patients are prescribed a course (about 12 months, but treatment can last for 2 years) hormonal therapy in the form of fairly high doses of anti-inflammatory glucocorticosteroids.

Patients with threatened blindness are prescribed Prednisolone (so-called pulse therapy). This drug is taken strictly after meals, at least three times a day, in a total volume of up to 61 milligrams.

In some cases, even 61 milligrams of daily intake is ineffective, and the dose is increased even to 92 mg. However, only the treating specialist can calculate the exact volume of the drug.

Prednisolone, even at the initial stage of administration, causes favorable dynamics: the temperature drops, the patient’s appetite and mood improve, and the erythrocyte sedimentation rate reaches normal.

This high dose is used in the first month of treatment, after which it is gradually reduced.

If there is a threat of serious consequences (for example, in case of individual intolerance to this drug), the patient is initially administered intravenously 1 gram of methylprednisolone once.

Along with Prednisolone, patients are prescribed vasodilating and vasodilating medications.

In case of a complicated course of the disease (the occurrence of aneurysms and thrombosis), as well as the ineffectiveness of medications, vascular surgery is resorted to. Naturally, with an early diagnosis, the prognosis for cure will be more optimistic.

Superficial temporal artery, atemporalis superficialis. One or two terminal branches of the external carotid artery. Together with the auriculotemporal nerve they go in front of the auricle. Rice. A, B.
Branch of the parotid gland, ramus parotideus. Supplies blood to the gland of the same name. Rice. A.
Transverse artery of the face, a. transversa faciei (facialis). Passes below the zygomatic arch under the fascia of the parotid gland towards the cheek. Rice. A.
Anterior auricular branches, rami auriculares anteriores. Numerous branches to the auricle and external auditory canal. Rice. A.
Zygomaticoorbital artery, azygomaticoorbitalis. Passes above the zygomatic arch to the lateral edge of the orbit. Rice. A.
Middle temporal artery, a. temporalis media. It extends above the zygomatic arch and supplies blood to the muscle of the same name. Rice. A.
Frontal branch, ramus frontalis. Anterior branch of the superficial temporal artery. Anastomoses with the vessel of the same name on the opposite side, the supraorbital and supratrochlear arteries (branches of the internal carotid artery). Rice. A.
Parietal branch, ramus parietalis. Posterior branch of the superficial temporal artery. Anastomoses with the branch of the same name on the opposite side, the posterior auricular and occipital arteries. Rice. A.
Maxillary artery, a. maxillaris. Large terminal branch of the external carotid artery. It begins below the temporomandibular joint, passes from the outer or inner side of the lateral pterygoid muscle and branches in the pterygopalatine fossa. Rice. A, B.
Deep auricular artery, aauricularis profunda. It goes back and up to the temporomandibular joint, external auditory canal and eardrum. Rice. B.
Anterior tympanic artery, a. tympanica anterior. Accompanied by the chorda tympani, it enters the tympanic cavity through the petrotympanic fissure. Rice. B.
The inferior alveolar artery, a alveolaris inferior. Passes between the medial pterygoid muscle and the ramus of the mandible. The canalis mandibulae continues to the mental foramen. Rice. B.
Dental branches, rami demotes. They go to the roots of the teeth. Rice. B. 13a Periodental branches, rami peridentales.
Mylohyoid branch, ramus mylohyoideus. It begins in front of the opening of the lower jaw and with n.mylohioideus lies in the groove of the same name. Anastomoses with a.submentalis. Rice. B.
Mental branch, ramus mentalis. Terminal branch of the inferior alveolar artery. Supplies blood to the chin. Rice. B.
Middle meningeal artery, a. teningea media. It passes medially from the pterygoideus lat and through the foramen spinosum enters the middle cranial fossa, where it branches into terminal branches. Rice. B, V.
Accessory branch, ramus accessorius. It starts from the middle meningeal or maxillary artery and supplies the auditory tube and pterygoid muscles. Penetrates the skull through the foramen ovale and branches into the hard shell around the ganglion mgeminale.
Stony branch, ramus petrosus. It starts from the middle meningeal artery in the cranial cavity. Through the cleft canal, the greater petrosal nerve anastomoses with the stylomastoid artery. Rice. IN.
Superior tympanic artery, a. tympanica superior. It lies next to the stony branch and, together with n.petrosus minor, penetrates into the tympanic cavity. Rice. IN.
Frontal branch, ramus frontalis. Large terminal branch of the middle meningeal artery. Inside the skull it lies in a bony groove or canal at the edge of the lesser wings of the sphenoid bone. Rice. IN.
Parietal branch, ramus parietalis. Supplies blood to the posterior part of the dura mater in the area of the cranial vault. Rice. IN.
Orbital branch, ramus orbitalis. Passes through the superior orbital fissure to the lacrimal gland. Rice. IN.
Anastomotic branch [[with lacrimal artery]], ramus anastomoricus []. Rice. B. 23a Pterygomeningeal artery, apterygomeningea. It starts from the maxillary or middle meningeal arteries and enters the skull through the foramen ovale. It supplies blood to the tensor velum palatini muscle, the pterygoid muscles, the auditory tube, the dura mater of the brain, and the trigeminal ganglion.
Masticatory artery, a. masseterica. It passes over the notch of the lower jaw and supplies blood to the muscle of the same name. Rice. B.
The anterior deep temporal artery, and temporalis profunda anterior. It goes up and enters the temporalis muscle. Rice. B. 25a Posterior temporal artery, a. temporalis profundae anterior.
Wing-shaped branches, rami pterygoidei. The pterygoid muscles supply blood. Rice. B.
Buccal artery, a. buccalis. Passes forward and downward along the buccal muscle. Supplies blood to the cheek and gum. Rice. B.
Posterior superior alveolar artery, a. alveolaris superior posterior. Its branches enter the alveolar canals and supply blood to the upper molars, gums and mucous membrane of the maxillary sinus. Rice. B.
Dental branches, rami dentales. They are directed to the roots of the maxillary molars. Rice. B. 29a Periodental branches, rami peridentales.

Temporal arteritis – what is it and what does it mean?

People aged 50-70 years most often suffer from this disease.

Causes of temporal arteritis

Temporal arteritis - main symptoms

The first alarming symptom that cannot be ignored is the sudden onset of sharp pain in the temples and radiating pain in the tongue, neck and even shoulders.

Throbbing pain in the temples may be the first symptom of temporal arthritis.

In addition, secondary symptoms may indicate inflammation of the temporal arteries, among which the following are worth noting:

Temporal arteritis (giant cell arteritis)

Signs (symptoms)

Patients with temporal arteritis usually begin to complain of vision in one eye, but half of them notice symptoms in the fellow eye after a few days without treatment.

Headache

Pain in the scalp when touched (for example, scratching)

Temple pain (can be unbearable)

Temporal arteritis

Causes of temporal arteritis

Symptoms of temporal arteritis

Diagnosis of the disease

Treatment of temporal arteritis

Prevention of disease

Primary prevention of temporal arteritis is very difficult, because there is no established cause for the development of the disease. Secondary prevention (prevention of exacerbation) consists of lifelong prescription of steroid hormones and immunosuppressants.