The ESR is the most useful serum laboratory test for diagnosing polymyalgia rheumatica and temporal arteritis. Although the Creactive protein level is typically elevated in patients with these conditions, it provides no better data than the simpler and less expensive ESR.
Neurologic findings are present in approximately 30 percent of patients with biopsy-proven temporal arteritis. Neuropathies secondary to occlusion of the nutrient arteries are most common. Transient ischemic attacks and strokes resulting from carotid or vertebrobasilar disease are the next most frequent events. Compromise of the arteries supplying the otic region can lead to tinnitus, hearing loss and vertigo. Thoracic aortic aneurysms have also been related to systemic vascular diseases such as temporal arteritis.
Inflammation of the arteries supplying the eyes can lead to anterior ischemic optic neuropathy, which can cause blindness, the most feared complication of temporal arteritis. Classically, the loss of vision is described as being painless. Other visual symptoms may include amaurosis fugax, diplopia and partial loss of vision. Ocular symptoms are initially unilateral, with the second eye becoming affected in one to 10 days.
Another frequent complaint in temporal arteritis is jaw claudication resulting from inflammation of the maxillary artery. Chewing may produce pain bilaterally or predominantly on the affected side. Involvement of the lingual artery can result in pain and blanching of the tongue. Rarely, it can lead to gangrene of the tongue.
Connective tissue disease
Bone disease or osteomyelitis
Retinal vascular accident
Other causes of ophthalmoplegia