Complications, Risk Factors, And Causes Of Temporal Arteritis

The temporal arteries are blood vessels found around the temples and help supply blood to the brain. Temporal arteritis, a form of vasculitis, occurs when those vessels are contracted and inflamed. The ciliary arteries and the other larger vessels, which can lead to serious health complications. When left untreated, the condition can be very dangerous and potentially deadly. Temporal arteritis is a relatively rare disorder, and it is most common among those older than fifty. Commonly, temporal arteritis involves fatigue, fever, jaw pain, muscle aches, and loss of appetite among other symptoms. Overall, the causes and risk factors of temporal arteritis are not well understood, but researchers have pointed out some potential causes, risk factors, and common complications.

Immune System Attacks

The exact cause of temporal arteritis is not known, but there is some evidence the immune system is involved. A part of why the cause is unknown is that temporal arteritis is incredibly rare. Typically, the immune system keeps an individual healthy by keeping track of foreign particles and removing them. In temporal arteritis, the immune system is a bit overreactive. The cells of the immune system view the arteries as pathogens that do not belong to the individual, so it attacks them. This causes the inflammation response, as well as fever and pain. Why the immune system does this is not yet fully known, but it could be due to two potential things. One could be a fault in the immune system itself, causing it to develop attack cells that view the blood vessels as foreign. The other is the blood vessels themselves begin to develop cell surface proteins that elicit an immune response.

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Polymyalgia Rheumatica

Polymyalgia rheumatica, though not a life-threatening condition, can have a severe impact on an individual's quality of life. It is a disorder that causes inflammation of the joints and connective tissue. It mainly includes stiffness and achiness of the neck, hips, and shoulders. As with temporal arteritis, the cause is not known, but the immune system is a likely candidate. Oddly, this disorder frequently co-occurs with temporal arteritis. Both disorders are much more frequent among older adults, and both cause uncomfortable inflammation. Polymyalgia rheumatica is often treated with low doses of steroids or high doses in patients with temporal arteritis as well. Scientists are still trying to understand why these two disorders occur together. Regardless, if an individual is experiencing symptoms of either disorder, a physician should be consulted.

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Genetic Link

Along with immune system attacks, temporal arteritis may have a genetic link. Unlike some genetic disorders, however, temporal arteritis is not likely to have a single gene that determines if an individual will develop the disorder; instead, it is more likely there are certain genetic variants that increase the chances someone will develop temporal arteritis. This means environmental triggers are needed along with the genes. On chromosome 6, the human leukocyte antigen (HKLA) gene family is greatly involved with protein recognition in the immune system, so it is probably involved in temporal arteritis. The PTPN22 genes are also strongly associated with temporal arteritis, although the relationship is not as the HKLA genes. The PTPN22 gene is known to be involved in autoimmune disorders. As the genetics of temporal arteritis are better understood, it will be easier for scientists to understand how to treat the disorder.

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Aortic Aneurysm

Temporal arteritis can cause the blood vessels to become weaker than they were in the past. As damage in the blood vessel builds up, a bulge can begin to develop and blood pools in it. The bulge, called an aneurysm, can rupture, which can be fatal. In temporal arteritis, an aneurysm can develop in the aorta. An aortic aneurysm is incredibly life-threatening. If it ruptures, an individual can bleed out internally in seconds. Having an aneurysm in the aorta also increases the risk of aortic dissection, a tear in the wall of the aorta. This condition is also deadly. In patients with temporal arteritis who have no other risk factors for an aortic aneurysm, the risk of developing one is twice that of someone without temporal arteritis. Interestingly, diabetes protects against developing an aneurysm. If a patient ends up developing such an aneurysm, surgical intervention may be needed.

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Blindness

The temporal arteries branch off into some of the arteries that supply the eyes with blood. As such, temporal arteritis can affect those arteries as well. When this happens, blindness in one or both eyes can occur. Sadly, the vision impairment associated with temporal arteritis is usually severe and non-reversible. If only one eye is affected at first, steroid treatment is usually able to reduce or completely prevent damage in the other eye. The goal would be to see a doctor at the first sign of temporal arteritis so any severe complications can be avoided. In more recent years, treatments have been developed that help some patients recover from vision loss, but the outlook is not good. Of course, by better understanding the symptoms of the disease, one is better able to prevent this scary complication from taking place.

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Stroke

A stroke can be a complication of temporal arteritis. A stroke happens when the brain is deprived of blood flow and oxygen, which results in cellular death. The type of stroke that occurs in individuals with temporal arteritis typically occurs in the vertebrobasilar region or the back of the brain. There are different types of strokes, but temporal arteritis affected individuals experience ischemic strokes. This type of stroke is caused by a blockage of some sort in the flow of blood to the brain. Ischemic strokes in such cases are thrombotic in nature or occur due to a blockage native to the blood vessel of which it obstructs. A stroke is an uncommon manifestation of temporal arteritis. A stroke can occur because the blood vessels in the brain affected by temporal arteritis become narrowed and swollen due to inflammation. This swelling can become so severe that it obstructs the flow of blood to certain parts of the brain, depriving those cells of vital nutrients and oxygen. The cells begin to shut down and die, which causes the affected individual to experience the classic symptoms of a stroke.

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Gender

An individual's gender may make them more likely to develop temporal arteritis then those of the opposite gender. For every male affected by this disease, 3.7 females are affected. This uneven gender distribution is thought to be the result of the gender distribution amongst a combination of all possible underlying causes of the disease. Arterial degeneration and minute calcification of the blood vessel internal elastic membranes are more prevalent among women than men and can cause an individual to develop temporal arteritis. Another possible mechanism may have to do with the differences in the immune systems of females and males. Females are known to generally have increased immune reactivity to stimuli then males do. Females also have the ability to secrete larger quantities of anti-inflammatory cytokines and multiple antibody isotypes. This could cause the immune systems in some females to become overactive and result in the development of an autoimmune disease. It is the immune system of an affected individual that attacks the endothelial tissues, resulting in the development of temporal arteritis. A female who smokes or uses tobacco products is six times more likely to develop this disease than a woman who does not.

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Ancestry

An individual's ancestry can cause them to be at an increased risk of developing temporal arteritis. Individuals of northern European descent are at a greater risk of developing this disease than those of African or other heritages. Over 0.2 percent of individuals in northern European countries who are over fifty years old are affected by temporal arteritis each year. Over .022 percent of individuals in the same age group are affected by this disease annually in the United Kingdom. More than .032 percent of individuals in Scandinavian countries who are over fifty years old are affected by temporal arteritis every year. In southern European countries, .012 percent of individuals past their fifth decade of life are affected annually by temporal arteritis. Individuals who are of Asian and Hispanic descent have a lower risk of developing this disease. Individuals who have a heritage from a geographic region characterized by lower life expectancy then others are at a decreased risk of developing temporal arteritis. Ancestry may also be influenced by genetic predispositions of individuals of certain heritages, but the disease may not develop without the addition of environmental triggers.

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Age Of Individual

One of the biggest increased risk factors of temporal arteritis is the age of an individual. Temporal arteritis affects approximately twenty-four in every 100,000 individuals who are past their fifth decade of life. In the United States, over 110,000 individuals are affected by this disease, with an average onset around age seventy. Temporal arteritis development is rarely seen in individuals younger than fifty years old. The occurrence of this disease increases as an individual's age increases, with a peak between the seventh and eighth decade of life. Temporal arteritis is the most prevalent form of systemic vasculitis that affects elderly patients. While the exact reasons why this age group is primarily affected are not clear, it is known to have to do with the body's abnormal and maladaptive response to injury that occurs in the lining of the blood vessels (endothelium). This endothelial injury can be caused by oxidative stress, viral or bacterial infection, hypoxia, turbulent blood flow, tobacco use, hyperlipidemia, and high blood pressure. All of these types of endothelial injuries are more likely to occur and accumulate as individuals advance in age.