Inflammation of the temporal artery 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 the blood vessels. Inflammation leads to narrowing of the vascular lumen, difficulty in blood flow and the formation of favorable conditions for thrombosis. Violation of the blood supply to organs and tissues ends with their ischemia and the development of serious diseases. All vessels are exposed 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 by origin are:

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 their thrombosis. This condition is called thromboembolism.

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 the elderly, 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 old, inflammation of large arteries - in women of reproductive age.

Etiology

The causes of giant cell arteritis are currently 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, hepatitis.
Autoimmune theory, according to which Horton's syndrome is attributed to collagenoses. Foreign formations provoke the production of antibodies that attack the own tissues of the vessel. In some patients with arteritis, the same signs of damage to the connective tissue and blood vessels were found, as in nodular periarteritis. Arteritis often occurs in patients with dermatomyositis, scleroderma.

Temporal arteritis affects mainly large blood vessels, affecting 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, formation of a thrombus that completely clogs 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, stroke. Usually there is inflammation of the carotid arteries, aorta and other vascular structures that supply blood to the areas of the head and cerebral cortex, the optic nerve, the organ of vision, and some internal organs.

arterial change in giant cell arteritis

Inflammation in arteritis is focal or segmental in nature.: the vessels are not affected throughout their entire length, but in separate areas or segments. The elastic membrane is infiltrated by lymphocytes, the intima thickens, plasmocytes, epitheliocytes, histiocytes, multinucleated cells accumulate in it, forming extensive granulomas. Multinucleated giant cells are the 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 preceding the appearance of specific symptoms:

Fever,
Weakness,
Lack of appetite,
hyperhidrosis,
myalgia,
Noticeable weight loss.

The temporal artery with arteritis becomes inflamed in 90% of cases, temporal arteritis develops. Patients complain of constant headache of varying degrees of intensity. The temporal arteries swell, swell, the pulsation is weakened, their soreness occurs. If the 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 has a diffuse character. On palpation of 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, shoulder. The pain is pronounced, throbbing, aggravated by palpation, chewing. Vision is impaired, eyelid drooping, double vision and pain in the eyes are observed. On the arteries of the neck and upper limbs, the filling and pulse rate change: it first weakens, and then completely disappears. The muscles of the limbs weaken, polymyalgia develops - a special form of pathology, manifested by pain and stiffness of the muscles of the shoulder, pelvis, arms and legs.

With inflammation of the maxillary and facial arteries there is soreness and numbness of the masticatory muscles, tongue damage, toothache. Burning pain under jaw extending to upper lip, nose and corners of eyes. These signs are due to insufficient blood supply to the corresponding muscles.

The disease affects the blood vessels that supply 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, ischemia of the optic nerve 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 who lead a sedentary lifestyle, and in smokers with experience. Patients develop unreasonable fever, sudden weight loss, severe pain in the muscles and joints of the legs. On palpation, foci of compaction and nodules are found. These are arterial aneurysms.

Diagnostics

Arteritis is diagnosed and treated by rheumatologists with the involvement of specialists from other medical specialties - nephrologists, dermatologists, hematologists, cardiologists, neuropathologists, 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, measurement of pulse, auscultation of the heart and lungs,
General and biochemical blood test - increased ESR and C-reactive protein, moderate anemia,
vascular ultrasound,
Artery biopsy - detection 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 being a reliable prophylactic. Patients are prescribed high doses of corticosteroids for oral or parenteral administration - Decortin, Prednisolone, Medopred, Prednisol. Tablets are taken 3 times a day, preferably 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 bright therapeutic effect: body temperature normalizes, symptoms of intoxication and asthenia disappear, ESR decreases. Glucocorticoid drugs have a number of side effects, including hyperhidrosis, bruising, facial swelling, weight gain, osteoporosis in the elderly, psycho-emotional breakdowns.

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

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

To prevent thrombus formation and optimization of blood flow is carried out with heparin therapy. Treatment with "Heparin" lasts five to six days, after which they switch 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 the vessel, oncopathology, the formation of an aneurysm, surgical intervention is required. In such cases, an angioprosthesis or bypass is performed. During the operation, the affected areas of the vascular bed are removed, restoring the patency of the vessels.

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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 address the source of the problem. This is only an "ambulance" to alleviate the condition and relieve discomfort. If the symptoms listed above appear, you should consult a doctor and undergo a complete examination.

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

With timely access to 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 familiar life.

Patients who ignore persistent headaches are at risk of becoming disabled. Advanced forms of arteritis lead to adverse and rather serious complications that are difficult to treat and continue to progress.

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

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Temporal arteritis is a systemic lesion of arterial vessels of medium diameter. The inflammatory process mainly involves the carotid artery and its branches. Most often, the superficial temporal artery is subject to pathological changes, the specific granulomatous lesion of which gave 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, an infectious factor plays an important role in its development. Often there is a natural connection between the occurrence of arteritis and the transferred influenza and group B hepatitis. The genetic programming of the pathology also has its supporters. Cases of this rather rare disease were 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 characteristic onset of the disease is absent. Several options are possible: acute, subacute, but more often with a long period of precursors, which can last for several weeks or more than one month.

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

General malaise;

A slight increase in body temperature in the range of 37.2–37.5 ° C;

excessive sweating, especially at night;

Aches in the joints;

Pain in the muscles;

sleep disorders;

Weight loss.

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 the patients suffer from visual 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, wearing a headdress;

Transient pain and numbness in the tongue and lower jaw, which are aggravated by talking and chewing;

Painful tight compaction along the inflamed artery;

Visual impairment (decrease in acuity, diplopia (ghost image), blindness);

Neurological, mental disorders.

With the involvement of the aorta, coronary, renal, mesenteric arteries in the pathological process, which happens with severe untreated variants of the disease, aneurysm, angina pectoris and heart attack may develop, as well as impaired blood supply and function of the kidneys and intestines.

Diagnostics

The diagnosis of arteritis can be made by histological examination section of the superficial temporal artery obtained by biopsy. Sample collection is performed under local anesthesia and is not difficult. The detection of granulomatous inflammation of the vascular wall with the presence of giant cells is an indisputable proof of this pathology.

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

Criteria for recognizing temporal arteritis have been formulated and generally recognized. The diagnosis is reliable when there are three or more of the following factors:

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 in the blood, an increase in ESR.

Auxiliary value for differential diagnosis is provided by sphygmography, rheovasography, Dopplerography of the affected arteries. For the same purpose, the presence of C-reactive protein and the level of sialic acid, 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 that supply blood to the eyeball.

The basis of the treatment of the disease, without which it is impossible to achieve positive results, is the appointment steroid hormones(prednisone). 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, microcirculation-improving agents, and vitamins.

Forecast

Temporal arteritis is a serious condition. With untimely recognition and inadequate treatment, pathology poses a threat to the health and life of the patient. A timely diagnosis, the implementation of the recommendations of doctors can avoid complications and make the prognosis favorable.

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

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Causes

The true 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 affects 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 Hbs-antigen and antibodies to it were found in 33% of patients. The fact that many patients have HLA genes B14, A10, B8 speaks for predisposition.

The following video will tell you about what temporal arteritis is terrible for:

Symptoms of Horton's disease

In the early stages, temporal arteritis may not have symptoms. On the other hand, if the patient had previously suffered an infectious disease, temporal arteritis may have an acute onset, due to reduced immunity.

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

With the development of Horton's disease acquires vascular symptoms. For example:

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

Also, the disease is accompanied by lesions of 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 you identify the symptoms, do not start treating 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 their relief:

Diagnostics

Diagnosis begins with a visit to the doctor. The doctor collects an anamnesis, compares the patient's symptoms with the clinical picture of arteritis, and then prescribes additional studies:

Examination by an ophthalmologist and neurologist.
Biopsy of the temporal artery.
Clinical an-z blood showing the presence of anemia and leukocytosis.
Biochemical an-z of blood, revealing dysproteinemia.
Ultrasound of extracranial vessels.
MRI and CT.
Angiography.

There is a diagnostic table compiled by the association of rheumatologists, which has the following criteria:

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

If at least 3 criteria match, 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 and surgical. To understand who treats temporal arteritis, when and what treatment can be prescribed, let's take a closer look at each.

Therapeutic way

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

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

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

Surgical method

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

And about whether it is possible to treat temporal arteritis with folk remedies, we will tell further.

Folk remedies

Doctors strictly warn that treatment with folk remedies can adversely affect the patient's health. Since the disease progresses and alternative medicine treatment cannot affect it, the condition can reach serious complications.

However, folk remedies can positively affect 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.

Disease prevention

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 balanced;
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 states occur if the disease is started.

Complications can occur with hormonal therapy, usually in the form of reduced immunity, headache and individual symptoms.

Photo of Horton's disease (temporal arteritis)

Forecast

The prognosis for the 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 threatens?

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

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

People aged 50-70 years are most often affected by this disease.

Most often, the disease develops after 50 years, and its peak falls on the age of 70 years and 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 successfully treated today, which distinguishes it favorably from other inflammatory diseases of the body. And yet, to have 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. Nevertheless, 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, severe infectious diseases, the treatment of which was accompanied by the use of strong antibiotics, can be the impetus for the development of temporal arteritis. In addition, inflammation can be triggered by certain viruses that, once in the body, affect the walls of weakened arteries.

Temporal arteritis - the main symptoms

The first alarming symptom that should not be ignored is the sudden onset of a 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 a throbbing pain in the temples. Moreover, simultaneously with the pain symptom, a pronounced pulsation of the temporal artery can be felt during 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 also indicate inflammation of the temporal arteries, among which the following should be noted:

Temporal arteritis (giant cell arteritis)

Temporal arteritis, also known as giant cell arteritis, is an inflammatory disease of the medium-sized arteries that supply blood to 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 the age of 60 and is manifested by swelling and soreness 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 other arteries are also involved in the process with a long course of the disease. This disease is potentially dangerous for vision, but with timely and proper treatment, this can be avoided. The danger lies in the fact that blood passes poorly through the inflamed arteries to the eyes and optic nerves, therefore, 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

Soreness in the scalp when touched (eg, scratched)

Pain in the temple (may 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 pool of the external and internal carotid arteries and, very rarely, arterial trunks extending directly from the aortic arch.

This disease in the vast majority of cases is detected in patients of a fairly advanced age (in persons who have not yet turned 50, only isolated cases of the disease are diagnosed). When studying the features of temporal arteritis, it was found that very often the symptoms of this disease occur along 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 the numerous studies that have been carried out since the first description of the manifestations of temporal arteritis by the 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 entered into related marriages for a long time, the number of cases is much higher than in the population as a whole (the largest number of cases was found in the Scandinavian countries of Europe and the northern states of the USA).

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

Its main foci are concentrated in the vascular wall of the arteries of medium and small caliber. As a result of these processes, the normal blood flow becomes more difficult, the phenomena of dystrophy and ischemia develop in the tissues that are located behind the site of the vessel lesion.

Most often, the inflammatory process in the vascular wall in giant cell arteritis affects the arteries of the head, but in exceptional cases, with the rapid progression of inflammation, it is possible to damage the coronary arteries, vessels of the kidneys, intestines - parietal thrombi 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, the appearance of constantly subfebrile condition (the temperature does not rise above 37, 70C), which is often accompanied by sweating in the evening and at night. During the same period, discomfort or pain in the muscles and joints of the whole body may occur, causing insomnia in patients, and with the addition of nausea and lack of appetite, the patient's weight loss quickly begins to progress. The duration of the stage of prodromal events can vary from several weeks to several months, and an inverse relationship has been reliably established between the duration and severity of symptoms of polymyalgia rheumatica and the severity of the temporal arteritis itself (the shorter the precursor stage, the more severe the actual vascular lesion).

The most characteristic and subjectively difficult to tolerate symptom is headache. Most often, it focuses 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 in nature, and almost always it occurs spontaneously - the patient does not feel the harbingers 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 skin of the head dense and inflamed, sharply painful when trying to palpate the strand - the affected artery.

In cases where the process affects the arteries supplying the face area, the patient may experience "intermittent claudication" of the tongue, chewing and, very rarely, facial muscles, this greatly complicates the patient's normal communication (difficulties arise when talking) and nutrition (prolonged chewing food causes a sharp pain in the muscles of the face).

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

When the main arteries are involved in the process, changes develop, the distribution area of \u200b\u200bwhich 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 are inevitable, with damage to the aorta, a characteristic clinical picture of an aneurysm of its arch occurs, with damage to the arteries of the kidneys or intestines, 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. In the biochemical analysis of blood, signs of an active inflammatory process, changes in the coagulogram are found. An accurate diagnosis can only be made 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 appointment 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 also turns out to be necessary to prescribe immunosuppressants - these drugs are needed when there is a threat of developing blindness or when signs of a generalization of the process are detected (in this case, patients rarely live more than 6 months without treatment). 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, so the dose of hormones is selected based on the severity of non-specific laboratory indicators of inflammation (ESR, C-reactive protein).

In addition, with severe violations of blood clotting processes, anticoagulants of direct and indirect action, 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 toad, vitamins.

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Etiology

The causes of giant cell arteritis are currently 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, hepatitis.
Autoimmune theory, according to which Horton's syndrome is attributed to collagenoses. Foreign formations provoke the production of antibodies that attack the own tissues of the vessel. In some patients with arteritis, the same signs of damage to the connective tissue and blood vessels were found, as in nodular periarteritis. Arteritis often occurs in patients with systemic lupus erythematosus, dermatomyositis, 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 preceding 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, measurement of pulse, auscultation of the heart and lungs,
General and biochemical blood test - increased ESR and C-reactive protein, moderate anemia,
vascular ultrasound,
Artery biopsy - detection of multinucleated giant cells,
arteriography,
fundus examination,
Ophthalmoscopy - detection of ischemic neuritis of the optic nerve.

Treatment

Persons who do not tolerate glucocorticoids are treated with Methotrexate, Azathioprine and other drugs in 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 address the source of the problem. This is only an "ambulance" to alleviate the condition and relieve discomfort. If the symptoms listed above appear, you should consult a doctor and undergo a complete examination.

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

With timely access to 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 familiar life.

Blood vessels are some kind of channels, peculiar ways through which the body receives the necessary nutrients and atomic oxygen, giving away spent and simply harmful substances in exchange for release into the environment. Unfortunately, vessels, like other organs, are susceptible to various diseases, for example, one of the most typical angiitis is temporal arteritis in young and old people.

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

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

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 form. As a result, breaking its functionality.

Causes

The causes of temporal arteritis in young people are different. Like other tonsillitis, it occurs both as an independent pathological process (primary arteritis), the causes of which are not thoroughly determined by science (versions of its occurrence from an infectious factor to a hereditary predisposition), and as a concomitant disease (most often accompanies such a disease 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 drop in immunity. Also, many experts consider taking large doses of antibiotics as a provoking agent.

The disease is quite common, affecting an average of 19 people out of a hundred thousand.

Pathogenesis

Horton's disease refers 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 are most often inflamed - the head, shoulders, arms, arteries of the eyes, vertebral arteries, and even the aorta.

Patients who are diagnosed with temporal arteritis are predominantly elderly people over 59 years of age. Particular mass character is observed in persons older than 71 years. It is noteworthy that women among the sick are about four times more than men.

It is not difficult to detect the temporal artery: it is enough with a little pressure to feel a moderate pulsation of the vessel by touching your temple with your fingertips. Affected by this disease, the artery causes a sharp swelling of the temple itself and the scalp. The tissues around the inflamed vessel are 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 the so-called inflammatory mediators by the affected cells, which spread from the inflamed vessel to the adjacent tissues.

Temporal arteritis, unlike all other inflammations of the arteries, responds well enough to treatment. The main thing is to diagnose the disease in the early stages and conduct adequate therapy.

Symptoms of temporal arteritis are quite typical.

The characteristic manifestations of temporal arteritis should alert the doctor during the initial admission of such a patient:

hyperemia of facial tissues, pronounced relief of facial vessels;
complaints about a local increase in temperature;
acute, throbbing, often difficult to bear pain at the site of 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 has a drooping of the upper eyelid of the affected side of the face.
Such patients see objects blurry, not clearly, they complain of "doubling" in the eyes, a decrease in visual acuity of one (over time, without treatment, the second eye is affected). The deterioration of vision is, as it were, temporary, transient. The patient complains of headache, general weakness and bad mood.
When eating, there is pain in the jaw. Also noticeable is increased, abnormal soreness when touching, 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. That 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 in order to detect their soreness. On examination, the temporal artery may be thickened and hard to the touch. The pulse in the area of inflammation is weakly expressed, or not felt at all;
eye pressure and body temperature are measured.
with the help of medical devices, auscultation of internal organs (lungs and heart) is performed;
an ultrasound examination of the blood vessels is performed;
assigned;
the patient's blood is examined in the laboratory (general and biochemical tests). Temporal arteritis is characterized by anemia. Moreover, in the 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 injuries and inflammations has been significantly increased.

It happens that all these methods still do not allow you 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 the organ is taken for the purpose of its microscopic examination for the presence of affected cells. A biopsy allows you to diagnose the disease with 100% 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 take up to 2 years) hormone therapy in the form of fairly high doses of anti-inflammatory glucocorticosteroids.

Patients with threatening 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, the exact amount of the drug can only be calculated by the treating specialist.

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

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

In the event of a threat of serious consequences (for example, with individual intolerance to this drug), the patient is initially administered intravenously once with 1 gram of methylprednisolone.

Simultaneously with Prednisolone, patients are prescribed vasodilators and vasoconstrictors.

With a complicated course of the disease (the occurrence of aneurysms and thrombosis), as well as the ineffectiveness of drugs, they resort to vascular surgery. Naturally, with an early diagnosis, the prognosis for a cure will be more optimistic.

Superficial temporal artery, atemporalis superficialis. One or two terminal branches of the external carotid artery. Together with the ear-temporal nerve, they go in front of the auricle. Rice. A, B.
Branch of the parotid gland, ramus parotideus. It 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 in the direction of the cheek. Rice. A.
Anterior ear branches, rami auriculares anteriores. Numerous branches to the auricle and external auditory canal. Rice. A.
The zygomatic-orbital artery, azygomati-coorbitalis. Passes above the zygomatic arch to the lateral edge of the orbit. Rice. A.
Middle temporal artery, a. temporalis media. It departs 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. It 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. It anastomoses with the same-named branch of the opposite side, the posterior auricular and occipital arteries. Rice. A.
Maxillary artery, a. maxillaris. Large terminal branch of the external carotid artery. It starts 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 ear artery, auricularis profunda. Goes back and up to the temporomandibular joint, external auditory canal and tympanic membrane. Rice. B.
Anterior tympanic artery, a. tympanica anterior. Accompanied by chorda tympani, it enters the tympanic cavity through the stony-tympanic fissure. Rice. B.
Inferior alveolar artery, a alveolaris inferior. Passes between the medial pterygoid muscle and the branch of the lower jaw. In the canalis mandibulae it 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.
Maxillary-hyoid branch, ramus mylohyoideus. It starts 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.
Chin branch, ramus mentalis. Terminal branch of the inferior alveolar artery. Blood supply to the chin. Rice. B.
Middle meningeal artery, a. teningea media. It passes medially from t. pterygoideus lat and enters the middle cranial fossa through the spinous foramen, 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, pterygoid muscles. Penetrates the skull through the foramen ovale and branches in the hard shell around the ganglion mgeminale.
Stony branch, ramus petrosus. It originates from the middle meningeal artery in the cranial cavity. It anastomoses with the stylomastoid artery through the cleft of the canal of the greater stony nerve. 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 lies in a bony groove or canal at the edge of the lesser wings of the sphenoid bone. Rice. IN.
Parietal branch, ramus parietalis. Blood supply to the back of the hard shell in the region 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 muscle that strains the palatine curtain, the pterygoid muscles, the auditory tube, the dura mater and the trigeminal ganglion.
Chewing artery, a. masseterica. Passes over the notch of the lower jaw and supplies blood to the muscle of the same name. Rice. B.
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.
Pterygoid branches, rami pterygoidei. Blood supply to the pterygoid muscles. Rice. B.
Buccal artery, a. buccalis. Passes along the buccal muscle forward and down. Blood supply to the cheek and gums. 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 go to the roots of the molars of the upper jaw. Rice. B. 29a Periodental branches, rami peridentales.

Temporal arteritis - what is it and what threatens?

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

People aged 50-70 years are most often affected by this disease.

Causes of temporal arteritis

Temporal arteritis - the main symptoms

The first alarming symptom that should not be ignored is the sudden onset of a 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 also indicate inflammation of the temporal arteries, among which the following should be noted:

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

Soreness in the scalp when touched (eg, scratched)

Pain in the temple (may be unbearable)

Temporal arteritis

Causes of temporal arteritis

Symptoms of temporal arteritis

Diagnosis of the disease

Treatment of temporal arteritis

Disease prevention

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