Temporal arteritis

Historical note and nomenclature
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By James Goodwin MD

The earliest case report of what was probably temporal arteritis is attributed to Ali Ibn Isa, a 10th century oculist (Woods 1936). Hutchinson described another early case in a man of 80 named Rumbold, who presented with painful, swollen, and reddened temporal arteries in the apparent absence of systemic symptoms. The inflammation subsided gradually and left the arteries as "pulseless impervious cords" (Hutchinson 1889). Some authors have since referred to temporal arteritis as Rumbold disease.

Credit for the earliest complete description of the disease with pathologic documentation of characteristic inflammation and giant cells in the temporal artery must be accorded to Horton and colleagues from the Mayo Clinic. The following is their succinct clinical description derived from examining 2 patients:

Both patients were admitted to the Clinic in the spring of 1931 because of fever, weakness, anorexia, loss of weight, anemia, mild leukocytosis, and painful, tender areas over the scalp and along temporal vessels. These manifestations had been present for 4 weeks to 6 weeks. Temporal artery biopsy in these 2 cases yielded granulomatous arteritis and periarteritis (Horton et al 1932).

Since this report, temporal artery biopsy has remained as the mainstay of pathologic diagnosis, though biopsy of other accessible cranial vessels has occasionally been advocated.

As cases accumulated, it became apparent that temporal arteritis usually presents with headache and symptoms of systemic illness exclusively in elderly persons. Another painful syndrome, now called "polymyalgia rheumatica" after Barber (Barber 1957), shares with temporal arteritis the strong predilection for the elderly and the association with signs and symptoms of systemic illness. In the mid-1950s the concept that temporal arteritis and polymyalgia rheumatica are but 2 clinical manifestations of the same basic disease process was introduced (Paulley and Hughes 1960). Hamrin and Ostberg both provided landmark publications, the former reporting his series of 93 cases of polymyalgia rheumatica with analysis of the relationship with temporal arteritis and underlying vascular pathology, and the latter reporting an autopsy study that revealed the link between the clinical syndrome called "polymyalgia rheumatica and giant cell arteritis of the aorta and its main branches" (Hamrin 1972; Ostberg 1973).