What are the key clinical features that should raise suspicion for temporal arteritis in a patient over 50?

Key clinical features raising suspicion for temporal arteritis (giant cell arteritis) in patients over 50 years include:

• New onset localized headache, often temporal, which may be severe and persistent.
• Scalp tenderness, especially over the temporal artery.
• Jaw claudication—pain or fatigue in the jaw muscles on chewing.
• Visual symptoms such as transient or permanent visual loss, diplopia (double vision), or visual field defects.
• Constitutional symptoms including unexplained fever, weight loss, and fatigue.
• Symptoms of polymyalgia rheumatica such as proximal muscle stiffness and pain.
• Physical signs such as a thickened, tender, or pulseless temporal artery on examination.

Laboratory findings supporting suspicion include elevated inflammatory markers: raised erythrocyte sedimentation rate (ESR) often >50 mm/hour, elevated C-reactive protein (CRP), normochromic normocytic anemia, and thrombocytosis, although normal ESR does not exclude the diagnosis.

Because temporal arteritis is a medical emergency due to the risk of irreversible vision loss, any new visual symptoms or jaw claudication in a patient over 50 should prompt urgent specialist referral and initiation of high-dose glucocorticoids without delay.

These clinical features are consistent with UK guidelines emphasizing the importance of early recognition and treatment to prevent serious complications ¹. The literature similarly highlights these symptoms as key diagnostic clues, noting that headache and jaw claudication are among the most specific clinical features (Smetana and Shmerling, 2002).