Though most physicians are familiar with temporal arteritis, a primary care physician may refer a patient to a rheumatologist, who may specialize in its treatment. Certain criteria have been established for the diagnosis of temporal arteritis. These include:
* Age of 50 or older at onset of the disease
* Localized headache that is new in onset
* Tenderness or decreased pulse of the temporal artery
* Erythrocyte sedimentation rate (ESR) higher than 50 millimeters per hour
* Arterial biopsy revealing characteristic signs of temporal arteritis
In evaluating a suspected case of temporal arteritis, a physician will review the patient’s medical history, including symptoms, and perform a physical examination. In this physical exam, the physician will look for an abnormal temporal artery that may be tender to the touch, inflamed, and with a reduced pulse and a hard, cord-like feel and appearance.
Several imaging tests may be used in the diagnosis of temporal arteritis. These include:
* Ultrasound. Imaging using high-frequency sound waves. May detect swelling of temporal arteritis. Doppler ultrasound may be used to detect narrowing and decreased blood flow of the arteries in the head.
* Cerebral angiography. A form of minimally invasive x-ray where a flexible tube (catheter) is inserted into an artery and threaded into the cerebral arteries in the brain. A contrast medium is injected and x-rays are taken as the medium fills the arteries. This reveals arterial blood flow and may be used to detect reductions in that flow.
* CAT scan (computed axial tomography) or MRI (magnetic resonance imaging). May detect involvement of large arteries. These tests also have the capacity to follow changes in the thickness of arterial walls that cannot otherwise be detected.
A temporal artery biopsy is the only way to confirm the diagnosis. Multiple samples may be needed because inflammation may not occur in all parts of the artery. A positive biopsy will reveal abnormal and enlarged cells in the artery walls. In many cases, a negative result will prompt another biopsy from the other side of the head to ensure that inflammation is not present.
Most other laboratory tests are benign in patients with temporal arteritis. However, some are useful in diagnosis. These include:
* Complete blood count. In many cases of temporal arteritis, levels of red blood cells are elevated.
* Sedimentation rate. This test measures how quickly red blood cells fall to the bottom of a tube of blood. When cells drop rapidly, inflammation may be present. The sedimentation rate is typically elevated in temporal arteritis. This test may be used throughout treatment to monitor the disease and the success of treatment.
* C-reactive protein test. Measures levels of C-reactive protein, a substance that the liver produces when inflammation is present. These levels may be elevated in temporal arteritis.
Patients who may have temporal arteritis are advised to see an ophthalmologist promptly for a complete eye exam to detect any risk to vision or loss of vision and to prevent further impairment.
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