Horton’s disease: what is it?

Horton’s disease is characterized by a inflammation of the wall of arteries. It particularly affects the temporal arteries, located on the temples at the level of the hairline, which is why it is also called temporal arteritis or giant cell arteritis. Horton’s disease mainly affects people over the age of 50, with a peak in frequency around 75-80 years. We estimate his prevalence to 1 in 11,000 in the general population, against 1 in 120 among those over 80.

Symptoms of Horton’s disease

The symptoms are varied and sometimes not very suggestive.

• fatigue, weight loss
• fever
• headaches that are intense and that spread to the temples and the back of the neck
• difficulty chewing (limp jaws)
• swelling of the temporal arteries and no pulse
• joint pain and stiffness the level of Bowl, shoulders and neck (pseudo-rhizomelic arthritis)
• Raynaud’s syndrome
• dermatological and respiratory symptoms (dry cough)

The main complication is loss of vision (amaurosis), with a sudden, unilateral drop invisual acuity. 10% of patients are thus suffering from total and irreversible blindness.

Causes of Horton’s disease

Horton’s disease is caused by the infiltration of immune cells (giant cells) into the lining of the arteries. The latter thickens and swells, which prevents the passage of blood and causes a lack of oxygenation. It is this poor oxygenation that leads to headaches and degeneration of the nerve optic (optic neuritis ischemic acute anterior, NOIAA). The exact causes of the disease, which could be due to an imbalance of the immune system which turns against the body (autoimmune disease). Genetic factors are also involved.

Treatment of Horton’s disease

The only possible treatment is the administration of corticosteroids such as prednisone. An initial “attack” phase, with high doses of corticosteroids, lasts a few weeks. Sometimes anticoagulant therapy such asaspirin to reduce the risk of clot (thrombosis) in the affected arteries. The regression of symptoms is sometimes spectacular, but treatment should be continued for at least 18 months or even several years. Degraded vision, however, cannot be recovered. Prolonged corticosteroid therapy causes severe side effects in some patients (hypertension, osteoporosis, digestive disorders, weight gain …) and therefore requires close medical monitoring.