Eshaghian J
Doc Ophthalmol. 1979 Sep 17;47(1):43-67. doi: 10.1007/BF00145369.
It is important to establish the diagnosis of temporal arteritis because the disease is treatable; treatment may prevent blindness and even death. Temporal arteritis usually occurs in people older than 51 years of age, although very rarely, histologically documented disease occurs in younger people. The onset may be occult, so that there are few findings. A multitude of signs and symptoms may occur such as fever, headaches, malaise, weight loss, anemia, stroke, cranial nerve palsies, polymyalgia rheumatica, aortitis and other large vessel involvement. The eye may suffer from ischemic optic neuropathy (anterior or posterior), central or cilio-retinal arterial occlusion, ophthalmic artery ischemia, or extraocular muscle palsies. An arterial biopsy showing giant cell arteritis establishes the diagnosis. However, a negative biopsy does not rule out the disease because of the occasional presence of skip areas. Arteriography has only rarely yielded a positive temporal artery biopsy when the initial biopsy done elsewhere was negative. As a diagnostic parameter, the erythrocyte sedimentation rate is nonspecific, being elevated in diseases other than temporal arteritis and sometimes being falsely lowered by technical factors. Furthermore, the temporal artery biopsy is occasionally positive despite a normal erythrocyte sedimentation rate. Treatment is aimed at relieving the patient's symptoms and normalizing the erythrocyte sedimentation rate. Because of the wide spectrum of clinical and laboratory finding in temporal arteritis, no one specific treatment regimen with systemic corticosteroids works for all patients. Temporal arteritis is a well known disease of the elderly which ir rarely fatal but results in significant visual morbidity (Hinzpeter & Naumann, 1976; Spencer & Hoyt, 1960). Since Hutchinson's (1890) description, more than a thousand articles have been written on the subject (Cohen & Smith, 1974). Despite this, many unanswered questions and controversies remain concerning the diagnosis, prognosis and treatment of temporal arteritis. My goal is to review these questions and areas of controversy.
颞动脉炎的诊断至关重要，因为该疾病是可治疗的；治疗可预防失明甚至死亡。颞动脉炎通常发生在51岁以上的人群中，尽管非常罕见，但组织学证实的疾病也会出现在年轻人中。发病可能隐匿，因此几乎没有明显症状。可能会出现多种体征和症状，如发热、头痛、不适、体重减轻、贫血、中风、颅神经麻痹、风湿性多肌痛、主动脉炎和其他大血管受累。眼睛可能会出现缺血性视神经病变（前部或后部）、中央或睫状视网膜动脉阻塞、眼动脉缺血或眼外肌麻痹。动脉活检显示巨细胞动脉炎可确诊。然而，活检结果为阴性并不能排除该疾病，因为偶尔会出现跳跃区域。当初始活检在其他地方为阴性时，血管造影很少能使颞动脉活检结果呈阳性。作为诊断参数，红细胞沉降率是非特异性的。在颞动脉炎以外的疾病中也会升高，有时还会因技术因素而被错误地降低。此外，尽管红细胞沉降率正常，颞动脉活检偶尔也会呈阳性。治疗旨在缓解患者症状并使红细胞沉降率恢复正常。由于颞动脉炎的临床和实验室检查结果范围广泛，没有一种使用全身性皮质类固醇的特定治疗方案适用于所有患者。颞动脉炎是一种众所周知的老年疾病，很少致命，但会导致严重的视力损害（欣茨彼得和瑙曼，1976年；斯宾塞和霍伊特，1960年）。自哈钦森（1890年）描述以来，关于这个主题已经撰写了一千多篇文章（科恩和史密斯，1974年）。尽管如此，关于颞动脉炎的诊断、预后和治疗仍有许多未解决的问题和争议。我的目标是回顾这些问题和争议领域。
