Point of Care

Manifestations and �onsequences The symptoms of temporal arteritis are highly variable. The occurrence of frequent (e.g., daily) temporal or occipital headaches that are resistant to regular analgesics is the most common symptom, found in two-thirds of patients.6 Fever, present in 50% of cases, is usually moderate.6 Anorexia with weight loss and asthenia is observed in one-third of patients.6 In 40% to 50% of cases, temporal arteritis is associated with polymyalgia rheumatica, which is characterized by sudden inflammatory pain in the shoulders and hips.2 Local manifestations are rarer and sometimes more subtle. Swelling of the temporal artery with induration is a pathognomonic sign of the disease (Fig. 2). The artery is sensitive to palpation, and arteriosclerotic occlusion may make it more difficult to find the pulse. Jaw claudication, occurring in one-third of subjects,6 is also characteristic of the disease.9 It is important, however, not to confuse jaw claudication with temporomandibular joint disorders or other abnormalities of the buccofacial sphere (Box 1). In cases of temporal arteritis, the pain is caused by partial occlusion and ischemia of the local arteries. The patient typically reports pain of the mandible, Temporal arteritis is an inflammatory disease of the large and medium arteries. It is characterized histologically by the presence of giant cells at the level of the arterial wall.1,2 Biopsy is required for histological confirmation of the disease,3 but the rate of false negatives on biopsy exceeds 60% the rate of true positives (Fig. 1).4 This high rate of false negatives is due in part to the segmental nature of the damage to the temporal artery, which does not necessarily occur along the entire length of the artery.3 At least 3 different names are used to refer to this clinical entity: temporal arteritis, Horton’s disease (not to be confused with Horton’s cephalalgia or cluster headache) and giant-cell arteritis. Although the condition is characterized by arteritis (among other things), it is not necessarily limited to the temporal artery; similarly, giant cells are not always present and may also be found in other forms of arteritis. The annual incidence of the disease among people 50 years of age or older in northern Europe and the northern United States is 5 to 30 per 100,000.2,5,6 Its occurrence is associated with certain known risk factors (Table 1). Temporal arteritis is a serious disease, and one of its most dreaded complications is blindness.7 However, if diagnosed early, it is relatively easy to What is the role of the dentist in the early diagnosis of temporal arteritis? Q u E s t i o n 1 The “Point of Care” section answers everyday clinical questions by providing practical information that aims to be useful at the point of patient care. The responses reflect the opinions of the contributors and do not purport to set forth standards of care or clinical practice guidelines. Readers are encouraged to do more reading on the topics covered. If you would like to contribute to this section, please contact editor-in-chief Dr. John O’Keefe at [email protected]. Point of Care