What Is It, Causes, Diagnosis, and More
Author: Ali Syed, PharmD
Editors: Alyssa Haag, Emily Miao, PharmD
Illustrator: Jillian Dunbar
Copyeditor: David G. Walker
What is jaw claudication?
Jaw claudication refers to pain or discomfort in the jaw that typically occurs while chewing. It is a classic symptom of giant cell arteritis (GCA), commonly known as temporal arteritis, which is a form of vasculitis, or inflammation of the blood vessels.
What causes jaw claudication?
Jaw claudication is typically caused by GCA. In GCA, the lining of the extracranial branches of the carotid artery (e.g., the internal maxillary artery and temporal arteries), which supply blood to the scalp, become inflamed. This inflammation leads to swelling in the affected arteries, which thereby narrows the artery. Subsequently, there is a reduction in the amount of blood and oxygen that is able to reach the tissues typically perfused by these arteries, like the masseter, or jaw muscles.
The exact cause of this inflammation is not currently known; however, it may be a result of an abnormal attack of the immune system on the artery walls. Genetic and environmental factors may contribute to the development of GCA, and subsequently, jaw claudication. Other risk factors may include being over the age of 50, being assigned female at birth, being of north European or Scandinavian descent, having a family history of GCA, or having a history of polymyalgia rheumatica (i.e., an inflammatory disorder that causes sudden onset pain and weakness in the shoulder and hips).
What does jaw claudication feel like?
Jaw claudication typically consists of feelings of pain, fatigue, or discomfort in the jaw muscles during chewing, particularly of tough foods (e.g., meat, chewing gum), or from prolonged speaking. Symptoms of pain and fatigue are typically relieved upon discontinuation of chewing or prolonged speaking.Jaw claudication can often be confused with symptoms of rheumatoid arthritis of the temporomandibular joint, temporomandibular joint disease, myasthenia gravis, tumors of the parotid gland, or occlusion of the external carotid artery. Since jaw claudication is highly predictive of GCA, other symptoms of GCA may coexist with jaw claudication. Some common symptoms of GCA may include severe temporal headaches; scalp tenderness; tongue, facial, joint, shoulder, or hip pain; unexplained fevers or anemia; and visual impairment, specifically transient monocular visual loss.
How is jaw claudication diagnosed and treated?
Jaw claudication can be difficult to diagnose as the symptom may resemble that of many other conditions. Diagnosis typically begins with a medical professional taking a thorough medical history and conducting a thorough physical exam of the individual. The physical exam should focus on the temporal arteries, which may feel tender; have a reduced pulse; and have a hard, cordlike feel and appearance.
Certain blood tests may also aid in the diagnosis of jaw claudication and the underlying cause. For example, erythrocyte sedimentation rate (ESR) is a blood test that indirectly measures the degree of inflammation present in the body. An elevated erythrocyte sedimentation rate is indicative of inflammation in the body. C-reactive protein (CRP) is another blood test that measures a substance the liver produces when inflammation is present and, when elevated, indicates the presence of inflammation in the body.
Certain imaging tests may be conducted in response to jaw claudication to diagnose underlying conditions. For example, doppler ultrasounds estimate blood flow through blood vessels, magnetic resonance angiography produces detailed images of blood vessels, and positron emission tomography (PET) produces detailed images of large blood vessels and highlights areas of inflammation.
Lastly, the gold standard method of diagnosing the underlying cause of jaw claudication is by taking a temporal artery biopsy. If the underlying cause of jaw claudication is GCA, the biopsy may show granulomatous inflammation with abnormally large cells, called giant cells. However, many patients with GCA have a negative temporal artery biopsy. Literature reviews regarding diagnosis of GCA propose that a temporal artery biopsy should not change the management of GCA and that non-invasive imaging modalities may be sufficient to confirm the diagnosis.
Treatment of jaw claudication typically begins with correct diagnosis and corresponding treatment of the underlying cause. In the case of GCA, treatment primarily consists of high dose corticosteroids, such as prednisone. Once stable, the dose of corticosteroids may be gradually reduced to the lowest effective dose. During this period, some symptoms such as headaches may return, which can be treated with slight increases in the corticosteroid dose.
Since high dose corticosteroids can lead to significant side effects (e.g., weakened bones, high blood pressure and blood sugar, mood swings, muscle weakness, cataracts, and infections), it is important to monitor the individual's bone density and to initiate prompt calcium and vitamin D supplementation to prevent bone loss. Alternative therapy options for GCA include using immune system suppressant drugs, such as methotrexate or tocilizumab.
What are the most important facts to know about jaw claudication?
Jaw claudication refers to pain or discomfort in the jaw that typically occurs while chewing. It is a classic symptom of giant cell arteritis (GCA), commonly known as temporal arteritis, which is a form of vasculitis, or inflammation of the blood vessels. The exact cause of this inflammation is not currently known; however, it may be a result of an abnormal attack of the immune system on the artery walls. Genetic and environmental factors may also contribute to the development of GCA and, subsequently, jaw claudication. Jaw claudication typically consists of feelings of pain, fatigue, or discomfort in the jaw muscles during chewing, particularly of tough foods (e.g. meat chewing gum), or from prolonged speaking. Diagnosis of jaw claudication may involve history and physical examination, blood tests, imaging techniques, and most importantly, a temporal artery biopsy. Treatment of jaw claudication typically begins by corresponding treatment of the underlying cause. In the case of GCA, treatment primarily consists of high dose corticosteroids, such as prednisone.
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Resources for research and reference
Cleveland Clinic (2019). Temporal Arteritis. In Cleveland Clinic. Retrieved September 19th, 2021, from: https://my.clevelandclinic.org/health/diseases/15674-temporal-arteritis
Goodman Jr., B. W., & Shepard, F. A. (1983) Jaw claudication. Postgraduate Medicine, 73(2), 177-183, DOI: 10.1080/00325481.1983.11697764
Jaw Claudication. In Health Jade. Retrieved September 19th, 2021, from https://healthjade.net/jaw-claudication/
Peral-Cagigal, B., Perez-Villar, A., Redondo-Gonzalez, L. M., Garcia-Sierra, C., Morante-Silva, M., Madrigal-Rubiales, B., & Verrier-Hernandez, A. (2018). Temporal headache and jaw claudication may be the key for the diagnosis of giant cell arteritis. Medicina Oral, Patologia Oral y Cirugia Bucal, 23(3), e290-e294. DOI: 10.4317/medoral.22298
Sato, H., Inoue, M., Muraoka, W., Kamatani, T., Asoda, S., Kawana, H., & Wajima, K. (2017). Jaw claudication is the only clinical predictor of giant-cell arteritis. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology, 29(3), 264-269.
Vitiello, G. (2017). Jaw claudication and temporal artery abnormalities in giant cell arteritis: Take advantage of clinical clues. Journal of Neuro-Ophthalmology, 37(4), 458.