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4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] > [15] Temporal Arteritis > Flashcards

[15] Temporal Arteritis Flashcards

1
Q

What is temporal arteritis also known as?

A

Giant cell arteritis

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2
Q

What is temporal arteritis?

A

A granulomatous vasculitis of large and medium-sized arteries

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3
Q

What arteries are primarily affected in temporal arteritis?

A

Branches of the external carotid artery

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4
Q

How common is temporal arteritis as a vasculitis?

A

It is the most common form of systemic vasculitis in adults

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5
Q

How does the pathology begin in temporal arteritis?

A

Dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates

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6
Q

What immune mediators and cells are involved in temporal arteritis?

A
  • Th17 cells
  • IL-6
  • IL-17
  • IL-21
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7
Q

What can be used to suppress the inflammatory pathway in temporal arteritis?

A

Glucocorticoids

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8
Q

What are the risk factors for temporal arteritis?

A
  • Age >50
  • Female
  • Genetic factors
  • Smoking
  • Atherosclerosis
  • Northern European
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9
Q

Who should temporal arteritis be a differential in?

A

Anyone over 50 with headache, scalp tenderness, transient visual symptoms or unexplained facial pain

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10
Q

Headache is a presenting symptom in what percentage of patients with temporal arteritis?

A

85%

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11
Q

Where does the headache in temporal arteritis occur?

A

Temporal or occipital

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12
Q

How bad is the headache in temporal arteritis?

A

Usually severe

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13
Q

When may the headache in temporal arteritis be worse?

A

At night

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14
Q

What other symptoms may be present in temporal arteritis?

A
  • Jaw claudication
  • Anorexia
  • Weight loss
  • Fever
  • Malaise
  • Sweats
  • Fatigue
  • Depression
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15
Q

When may jaw claudication in temporal arteritis be prominent?

A

When talking or eating

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16
Q

What cause visual disturbances in temporal arteritis?

A

Inflammation of the branches around the ophthalmic artery leading to ischaemic optic neuritis

17
Q

What visual disturbances may occur in temporal arteritis?

A
  • Blurred vision
  • Amaurosis fugax
  • Transient or permanent visual loss
  • Diplopia
18
Q

What signs may (but potentially not) be found in temporal arteritis?

A
  • Abnormal palpation of the temporal artery
  • Bruits over carotid/axillary/brachial arteries
  • Tender muscles and joints
  • Ocular and fundoscopic evidence of ischaemic neuritis
19
Q

What abnormalities may be felt on palpation of the temporal artery?

A
  • Absent pulse
  • Beaded
  • Tender
  • Enlarged
20
Q

What should patients with suspected temporal arteritis be referred urgently for?

A

Temporal artery biopsy

21
Q

When should temporal artery biopsy occur in temporal arteritis?

A

Within 2 weeks of starting steroids

22
Q

What findings can be seen on biochemistry in temporal arteritis?

A
  • Elevated ESR and CRP
  • Normocytic normochromic anaemia
  • Thrombocytosis
  • LFTs elevated
23
Q

What are the differentials for temporal arteritis?

A
  • Migraine
  • Tension headache
  • Trigeminal neuralgia
  • Takayasu’s arteritis
  • Polyarteritis nodosa
  • Polymyositis
24
Q

What are the three potential management options for temporal arteritis?

A
  • Steroids
  • Low-dose aspirin
  • Tocilizumab
25
Q

When should steroids be started in temporal arteritis?

A

Once diagnosis is suspected

26
Q

What dose of steroids is given in temporal arteritis?

A

High dose

27
Q

What steroids should be given if there are no ischaemic or visual symptoms in temporal arteritis?

A

40mg prednisolone/day

28
Q

What is meant by ‘ischaemic symptoms” in the treatment of temporal arteritis?

A

Jaw and tongue claudication

29
Q

If ischaemic symptoms in temporal arteritis are present what steroids should be given?

A

60mg prednisolone/day

30
Q

If there are visual symptoms present in temporal arteritis what steroids should be given?

A

Admission for IV methylprednisolone

31
Q

How should patients with settling symptoms of temporal arteritis be weened off steroids?

A

Reduce in 10mg steps/2 weeks to 20mg then in 2.5mg steps

32
Q

At what dose of steroids can flare-ups of temporal arteritis be usually controlled?

A

At the dose they were last previously controlled

33
Q

What dose of aspirin should be started in temporal arteritis?

A

75mg/day

34
Q

What contraindicates the starting of aspirin in temporal arteritis?

A
  • Active peptic ulcer disease

- Bleeding disorders

35
Q

What is tocilizumab?

A

A novel biological agent with therapeutic and corticosteroid-sparing benefit for use in temporal arteritis

36
Q

What are the potential complications of temporal arteritis?

A
  • Loss of vision
  • Aneurysms, dissections and stenotic lesions of the aorta and its branches
  • CNS disease
  • Steroid related complications
37
Q

What CNS complications can occur in temporal arteritis?

A
  • Seizures
  • Cerebral vascular disease
  • Brain ischaemia
38
Q

What steroid-related complications can occur in temporal arteritis?

A
  • Osteoporosis
  • Corticosteroid myopathy
  • Bruising
  • Emotional symptoms
  • Hypertension
  • Diabetes
  • Elevated cholesterol and fluid retention
39
Q

What ‘emotional’ steroid-related side effects can occur in temporal arteritis?

A
  • Hypomania

- Depression

4/3: Elderly/Neuro Y3/4 - Neuro and Stroke [12] (33 decks)

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