Chapter 43

Question 1

How do temporal arteritis patients present?

Answer 1

Low grade fever, unilateral temporal headache scalp tenderness, elder patient greater than 50, weight loss

Question 2

What are the possible differential diagnoses for this patient?

Answer 2

Temporal arteritis, brain abscess, meningitis, encephalitis, infective endocarditis

Question 3

What is the best clue for temporal arteritis? What establishes the definitive diagnosis?

Answer 3

Elevated ESR, temporal artery biopsy

Question 4

What is a diagnostic work up for this patient?

Answer 4

CBC, BMP, blood culture, UA, urine culture, ESR, temporal artery biopsy, CT head, CXR (possible aneurysm)

Question 5

Why is the CT scan done?

Answer 5

Headache with constitutional symptoms (fevers fatigue anorexia and weight loss) warrants brain imaging

Question 6

What are the positive lab findings for this patient?

Answer 6

Normochromic normocytic anemia (anemia of chronic inflammation) and elevated ESR

Question 7

What should be done after positive ESR?

Answer 7

Steroid therapy (pending biopsy results)

Question 8

What are the criteria for temporal arteritis?

Answer 8

Greater than 50 years, new headache, temporal artery tenderness or decrease pulsations, Elevated ESR or CRP, Necrotizing vasculitis or granulomas on biopsy

Question 9

What’s the therapy for uncomplicated temporal arteritis?

Answer 9

Acute therapy: high-dose oral steroids (40 to 60 mg per day) until response is noted then slowly decrease dose by 10

Maintenance therapy: Once prednisone is 10 mg per day then gradually taper 1 mg decrements over a period of at least nine months

Question 10

How is complicated temporal arteritis (vision loss) treated?

Answer 10

Acutely initiate IV steroids (dexamethasone or methylprednisolone) for three days then switch to oral steroids then taper as if uncomplicated

Question 11

Why is the addition of low-dose aspirin needed?

Answer 11

To decrease the risk of blindness, TIA, stroke

Question 12

What prophylactic therapy in GCA is similar to PMR?

Answer 12

Prophylactic PPI, calcium plus vitamin D and baseline DEXA scan to assess bisphosphonate use

Question 13

What is temporal arteritis managed and patient?

Answer 13

If life-threatening diseases are part of the differential or if vision loss is present

Question 14

What needs to be surveyed during follow up, why?

Answer 14

Thoracic aneurysm through CXR, due to risk of developing large vessel vasculitis and aneurysm; ESR CRP CBC