General symptoms include weight loss, pyrexia
(may have acute onset), symmetrical muscle stiffness, and pain that is worse
in the morning. Cranial symptoms include paroxysmal burning pain (typically
unilateral and beginning behind one eye), headache, jaw claudication, rarely
scalp necrosis, or lingual ischemia secondary to arterial occlusion. Skin
overlying arteries may appear inflamed in the acute phase. Ocular problems
include blindness caused by anterior ischemic optic atrophy, transient
visual loss, and diplopia. The vasculitis increases the risk of aortic
aneurysm (usually thoracic/dissecting), coronary arteritis causing
myocardial ischemia, and cerebral arteritis causing infarction, most usually
in a posterior cerebral artery distribution. Vertebral arteritis may result
in auditory loss and vestibular dysfunction (vertigo). Abdominal
claudication and bowel necrosis are reported. Erythrocyte sedimentation rate
and C-reactive protein are elevated. Treatment consists of high-dose
glucocorticoid therapy in the acute phase, subsequently reduced to a lower
maintenance dose for up to 6 months.