Giant Cell Arteritis

Question 1

what is temporal arteritis

Answer 1

granulomatous arteritis of the aorta and large sized vessels affecting the superficial temporal artery
is a chronic vasculitis

Question 2

presentation of temporal arteritis

Answer 2

non specific headache / neck pain
tenderness over the temporal artery
vision changes (transient vision loss/ amaurosis fugax)
jaw claudication (if fascial artery is effected)
up to 50% of patient will also experience polymyalgia rheumatica

Question 3

investigations for temporal arteritis

Answer 3

ESR CRP
USS doppler of the temporal artery
diagnosis through biopsy

Question 4

what histological changes could you see on biopsy which are suggestive of temporal arteritis

Answer 4

giant cells
pan arthritis
lymphocytes and macrophages within the SM
skip lesion pattern to inflammation

Question 5

how is temporal arteritis managed

Answer 5

do not delay treatment for biopsy
60-100mg prednisolone PO for 1-2 weeks
tapering off for 6-12 months
consider osteoporosis medication

Question 6

what is the management for those with suspected temporal arteritis who present with acute visual changes

Answer 6

consider 1g methylprednisolone IV pulse therapy for 1-3 days
low dose aspirin to reduce thrombotic risk

Question 7

what is the most important complication to consider in temporal arteritis

Answer 7

vision loss / anterior ischemic optic neuropathy
due to reduced blood supply to the optic nerve (supplied by the central retinal artery)