Rheumatologist Questions Rheumatologist

Is my very visible superficial temporal artery a sign of giant cell arteritis?

Hi, about 10 days ago I noticed that my left temporal artery was TOTALLY visible. I had never noticed it before. Over the last days, I've observed that it stays visible when I'm at rest, so it's not related to exertion, being hot, etc.

I'm sure it's the artery (not vein) because it is colorless (not bluish), snakelike and I can CLEARLY feel my pulse at any point along its course. I palpated both temples at the same time, and pulse can be felt in both left and right temples at the same time.

At first, I didn't think much of it, but last night I figured I better look it up to be sure - and of course I came across Giant Cell Arteritis (also referred to as Temporal Arteritis).

So, looking at the symptoms and risk factors of GCA here is the pertinent information:

I am:
-40 y.o.
-Male
-I've had a left-side headache every day for going on 15 years now, especially behind the left eye. Sometimes it is worse, sometimes it is better - but always there. So, this makes it difficult to know if a new headache/pain has developed due to GCA. I don't think it has.
-No new eye/vision issues
-No pain on chewing, except sometimes my one tooth hurts on left side (believe this is unrelated)
-No jaw pain

Other medical conditions:
-ME/CFS and Fibromyalgia (severe, mostly wheelchair-bound with muscle weakness, muscle burning, and fatigue...even speaking for longer than 15 minutes is difficult)
-Had TIA 13 years ago.
-2 DVT's in my legs years ago. Likely due to being mostly bedbound for a period of a few months.
-Take Pradaxa 2x per day (last 1 year). Was previously on Coumadin (b/c of the DVT's) for last about 8 years.
-In addition to autoimmune issues I've already mentioned, I've had seborrheic dermatitis and tinea versicolor for years (likely due to lowered immunity).


Unfortunately, I've been housebound for the last 2 years, so popping out to get this checked isn't possible. I do have the ability to order a home CRP test.

My questions are:
-Is a CRP about as good as an ESR test to rule out GCA?
-With me being under 40 years old, male, and no new severe headache
- What are the chances this is GCA? So low that I shouldn't be concerned?

If it weren't a big deal, I'd just add it to the list of health issues, but untreated
GCA can result in severe complications (vision loss), so I wanted an expert opinion.

Male | 40 years old
Complaint duration: 10 Days
Medications: Pradaxa
Conditions: ME/CFS, Fibromyalgia, DVT, TIA, Diastolic Orthostatic Hypotension, Asymptomatic Mitral Valve Prolapse, Sebhorreic Dermatitis, Tinea Versicolor

3 Answers

Giant cell arteritis is extremely uncommon under 60 years of age. The ESR may be elevated by your other conditions. In this case a CRP would be a better test. And you are probably followed by a rheumatologist , so you should talk to that doctor. The definitive test for GSA is a temple artery biopsy. SO
Temporal arteritis is not defined by the visibility of the vessel, but certain signs and symptoms. To rule out this condition you should have a sedimentation and C-reactive protein drawn. If elevated in conjunction with temple pain, weight loss, jaw pain, even vision loss a temporal artery biopsy could be performed to diagnose this condition.
GCA almost never occurs before the age of 50 and the artery you can see, would be exquisitely tender, so you wouldn’t be able to feel your pulse, it would hurt too much to test it.