Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, MD
27 September 2006

WHAT IS ARTERITIS?

            A lady recently came to the clinic stating that her arms felt weak.  She said that the condition had faded in over several months but in the past week had become very problematic.  She gave the example of trying to put the dishes away out of the dishwasher.  The cups went on the top shelf of the cabinet.  She described having had friends over for coffee and there were ten cups in the dishwasher.  She could take one cup in each hand and put them up on the shelf.  By the time she was putting the fourth pair of cups up; her arms were so weak she said that she could barely lift them.  She rested for several minutes and finally got all ten cups back on the shelf, but said her arms were very painful and very weak by that time.  She wondered what might be wrong.  She said that she had been more tired recently but couldn’t really give an example of this.  On examination, there were no pulses at either wrist.  Both hands were colder than expected.  Listening to the upper arm on each side, there was a swishing noise like the singing of water in a pipe.  This was not normal.  Blood flowing through an artery should make no noise at all and hers were very noisy.  Several blood tests were done and a diagnosis of “giant cell arteritis” was made.  When I told her the name of the diagnosis, her obvious question was “What is that?”

            Another patient came to the clinic because he was having difficulty with his vision.  He was 75 years old and looked upon himself as being in perfect health, but noticed that everything was getting blurry recently and he was having unusual headaches.  On examination, there was marked tenderness in the area on the side of his head above the ears.  A blood test was done followed by a biopsy of one of the arteries on the side of his head.  A diagnosis of “temporal arteritis” was made.  Like the lady above, his first question was “What is that?”

            A third patient came to the clinic because of generalized fatigue that had been worsening over several months.  After an extensive workup, it was found that she had a condition called “Wegener’s granulomatosis”.  You might imagine she had the same question as the two patients above and it wasn’t much help to tell her that it was a form of arteritis.

            The word arteritis refers to an inflammation of arteries.  Arti- refers to the blood vessels that carry blood from the heart out to the tissues.  The suffix -itis means inflammation.  Therefore, arter-itis means inflammation of the arteries.  Arteritis is very strange disease that comes in multiple forms as the three people above illustrate.  For some reason that doctors don’t understand, the arteries in the side of the head and the eyes can be involved alone or alternatively simply the arteries that supply the arms may be involved.  Or lastly, simply the arteries that supply the kidneys may be involved.  Even though there are arteries all over the body, somehow arteritis may involve just one area, although symmetrically on both sides indicating that the condition is apparently organ specific.

            The natural history and progress of endarteritis is usually a very bad result.  A case of temporal arteritis can result in blindness.  Giant cell arteritis involving the arms can result in an inadequate blood supply to the muscles in the arms and the person becomes crippled.  Alternatively, involvement of the arteries that supply the kidneys can lead to kidney failure and the need for dialysis and a transplant.

            The basic disease process is the body making a mistake and believing that the arteries to one organ or another are not part of the body and need to be eliminated.  Thus, the bodys’ own natural defense mechanisms attack the arteries to a certain organ system.  Why this happens, we have not a clue.  Fortunately, it is relatively rare.

            Even more fortunately, there is effective treatment.  The use of cortisone (prednisone) in substantial doses is usually enough to turn off the disease process and allow blood supply to the involved organs to be maintained.  In the case of temporal arteritis in the gentleman who was losing his vision, recovery of his vision occurred over the course of about ten days, completely back to normal.  He requires the continued use of a low dose of cortisone over an extended period of time.  There are side effects that occur from the use of long term cortisone therapy but the side effects can be managed and are a fair trade to maintain one’s vision.

            Usually after several weeks to months of high dose cortisone treatment, the use of other medications to tell the body’s defense mechanisms to please leave those organs alone can be substituted and the dose of cortisone tapered down.  This is done slowly over several months as the alternative medications are substituted.   Indeed, the alternative medications do have their fair share of side effects, too.  One must, however, keep in mind that the side effects are usually a very fair trade to maintain the organ function in the kidneys or to maintain vision.

            The three patients mentioned above are examples that occurred in the recent past.  Unfortunately, arteritis can affect the brain or the heart or the lungs in addition to the examples given above.  The important step is to recognize the clinical condition and make the right diagnosis.  The healthcare providers at your local clinics run into these unusual cases periodically. With continued attention and sometimes referral, the right diagnosis can be achieved and appropriate treatment instituted.  The important step is for the patient to recognize that “something is wrong” and that fatigue or weakness which is felt is not just overwork or laziness causing the person’s tiredness.