Make the Diagnosis: Temporal Arteritis
Temporal arteritis is relatively rare, though the disease may be underdiagnosed.13 The prevalence increases with age, and it occurs more commonly among women and whites. One study found that, among white persons 50 years and older, the prevalence of temporal arteritis was 200 cases per 100 000; among persons older than 85 years, the prevalence was 1100 per 100 000.14 Most published series have been from northern Europe and the northern United States, but the disease has been observed worldwide.
Population for Whom Temporal Arteritis Disease Should Be Considered
Temporal arteritis should be considered in all adults aged 50 years and older with appropriate symptoms. Although prevalence varies by sex, race, and geographic locale, no single demographic factor among persons older than 50 years decreases the likelihood enough to exclude the diagnosis.
Detecting the Likelihood of Temporal Arteritis
One can estimate the likelihood of temporal arteritis by using either single features (and applying the summary LRs from our meta-analysis) or by using combinations of features, as established by the prediction rule of Younge et al1 (see Table 49-8).
Table 49-8The Single Best Findings or Combinations of Findings Can Be Used to Estimate the Probability of Temporal Arteritis |Favorite Table|Download (.pdf) Table 49-8 The Single Best Findings or Combinations of Findings Can Be Used to Estimate the Probability of Temporal Arteritis
| ||LR+ (95% CI) ||LR– (95% CI) |
|Single Best Findings Suggesting the Presence of Temporal Arteritis |
|Jaw claudication ||4.3 (3.0-6.1) || |
|Diplopia ||3.5 (1.8-6.8) || |
|Single Best Finding Suggesting the Absence of Temporal Arteritis |
|ESR < 50 mm/h (n = 5) || ||0.55 (0.38-0.80) |
|Combinations of Findingsa ||Posterior Probability, % |
|Headache + jaw claudication + scalp tenderness at age 60 y ||65 |
|Headache + jaw claudication + scalp tenderness at age 80 y ||74 |
|Headache + jaw claudication + scalp tenderness at age 60 y, ESR = 50 mm/h ||84 |
|Headache + jaw claudication + scalp tenderness at age 80 y, ESR = 50 mm/h ||88 |
|No headache + no jaw claudication + no scalp tenderness at age 60 y, ESR = 50 mm/h ||7 |
|No headache + no jaw claudication + no scalp tenderness at age 80 y, ESR = 50 mm/h ||10 |
Temporal artery biopsy and histologic evaluation is the reference standard for the diagnosis of temporal arteritis. Other means of diagnosis have been suggested, including positron emission tomography scanning15, 16...