Giant Cell Arteritis

Question 1

What is Temporal Arteritis?

Answer 1

AI granulomatous vasculitis affecting medium + large-sized vessels arteries

Question 2

Describe the epidemiology of Temporal arteritis

Answer 2

> 50s
F > M

Question 3

List 5 symptoms of Temporal arteritis

Answer 3

Headache
Scalp pain/ tenderness
Jaw claudication
Features of PMR
Systemic Sx: low-grade fever, anorexia, night sweats, fatigue

Question 4

Give 2 features of PMR that may be seen in patients with temporal arteritis

Answer 4

Aching
Morning stiffness in proximal limb muscles (not weakness)

Question 5

What accounts for the majority of ocular complications in temporal arteritis? What causes this? What is seen on fundoscopy?

Answer 5

Anterior ischemic optic neuropathy
Results from occlusion of the posterior ciliary artery (a branch of the ophthalmic artery)
→ ischaemia of optic nerve head. Fundoscopy: swollen pale disc + blurred margins

Question 6

What visual symptoms may arise in temporal arteritis?

Answer 6

Amaurosis fugax (transient visual loss)
Diplopia
Changes to colour vision
Partial/ complete loss of vision

Question 7

What is the most feared complication of temporal arteritis?

Answer 7

Permanent visual loss
May develop suddenly

Question 8

Describe management of suspected temporal arteritis

Answer 8

Immediate HIGH DOSE steroids
(prior to further Ix)
To reduce risk of permanent visual loss + cerebral ischaemia

Question 9

Describe the route of administration of high dose steroids in suspected temporal arteritis

Answer 9

No visual loss: Prednisolone 40-60mg PO OD
Visual loss: pulse therapy with Methylprednisolone IV (before PO Pred)

Question 10

What bloods are performed in temporal arteritis?

Answer 10

FBC: normal/ normocytic anaemia
CRP + ESR: raised

Question 11

What imaging is performed in temporal arteritis?

Answer 11

Vascular US (1st line if available)

Question 12

What is seen on vascular ultrasonography in temporal arteritis?

Answer 12

Wall thickening (non-compressible Halo sign)

Question 13

What is the gold standard test for definitively diagnosing temporal arteritis ?

Answer 13

Temporal artery biopsy
(may be falsely negative due to skip lesions)

Question 14

Describe management of Temporal arteritis

Answer 14

Prednisolone 40-60mg PO OD
Should be dramatic response, if not consider ddx
Slowly taper to lowest dose needed to control Sx

Question 15

Describe management of ocular symptoms in Temporal arteritis

Answer 15

Same-day ophthal review
(Visual damage is often irreversible)

Question 16

What should be co-prescribed alongside steroids in management of temporal arteritis?

Answer 16

Bisphosphonates (bone protection)
as long, tapering course of steroids