Giant Cell arteritis and Reynaud's Syndrome Flashcards
Define giant cell/temporal arteritis
- Temporal arteritis is inflammation and damage to the blood vessels that supply blood to the head
- If the inflammation affects the arteries in your neck, upper body and arms, it is called giant cell arteritis. Includes temporal arteritis
What is the etiology of temporal arteritis?
- Etiology and pathogenesis unknown
A. Humoral and cell-mediated immunity suspected
What demographic group is prone to temporal arteritis?
- Common in US & Scandinavian populations
- F>M
- Mean age 70 (range 50 - 90+)
What comorbidities are often asst with temporal arteritis?
- Chronic vasculitis involving medium & large diameter arteries in pts > 50 yrs
A. thoracic aorta, SC, carotids, and extracranial branches of the carotids (temporal)
B. 50% of patients also have polymyalgia rheumatica (PMR)
What are the sxs of temporal arteritis that are generally acute?
- Symptoms can be acute
- Fever
- Headache (severe, throbbing)
- Tenderness and sensitivity on the scalp
- Jaw claudication (pain in jaw when chewing)
- Tongue claudication (pain in tongue when chewing)
- Reduced visual acuity
- Diplopia
- Acute tinnitus
- Bruits
- Amaurosis fugax
What temporal arteritis sxs are gradual over several weeks?
- Fever (usually low-grade)
- Fatigue
- Malaise
- Unexplained weight loss
- Hyperhidrosis
What diagnostic tests are indicated in gc/temporal arteritis?
- CBC
- CRP
- ESR
- Temporal artery biopsy
- Fundoscopic exam
What are the common CBC results in giant cell/temporal arteritis?
anemia common
What are the common CRP results in giant cell/temporal arteritis?
elevated
What are the common ESR (erythrocyte sediment rate) results in giant cell/temporal arteritis?
- Elevated in > 90% of pts
2. > 50 mm/hr
What are the common temporal artery biopsy results in giant cell/temporal arteritis?
- Confirms GCA vasculitis
- Inflammatory infiltrate in media & adventitia, necrotizing arteritis
- Lymphocytes, eosinophils, mulitnucleated giant cells
What are the common fundoscopic exam results in giant cell/temporal arteritis?
- May have optic neuritis
- May be totally normal
- May have copper/silver wire abnormalities
- May have changes in optic disc
Why is treatment urgent for gc/temporal pts?
Delayed or untreated → permanent blindness
Start tx before biopsy
What is the treatment for GC/temporal arteritis?
- Biopsy can be done up to 14+ days after Tx started
- Prednisone 60 mg/day p.o.
A. Continue high dose prednisone x minimum 1 month before tapering
B. May be continued up to 1-2 yrs - Aspirin 81 mg qd
A. To prevent ischemic event (unless contraindicated) - Methotrexate
A. 0.3 mg/kg/wk po
B. Use if pt can’t tolerate steroids or recurrence as tapering off
What is the treatment of gc/temporal arteritis if there are visual disturbances?
→ IV methylprednisolone 500 to 1000 mg qd for 3 to 5 days, then switch to oral as above
Define Raynaud’s phenomenon
- Vasospastic disorder that produces an exaggerated response to cold temperatures or emotional stress, resulting in transient digital ischemia
- Affects 3% of population worldwide
What is stage I of Reynaud’s disease?
- Pallor phase
A. Spasm causes ↓ cutaneous blood flow
B. Pallor, numbness, paresthesias, pain in affected digits
What is stage II of Reynaud’s disease?
- Cutaneous cyanosis phase
A. Due to ↓ oxygenated blood in capillary bed
What is stage III of Reynaud’s disease?
- Hyperemic phase
A. ↑ Blood flow to affected digits → skin blushing
What demographic group is the primary form of reynaud’s common in?
- Occurs at 15-25 yr
- F>M
- More common in colder climates
What demographic group is the secondary form of reynaud’s common in?
- Begins after 35-40 yr
- High incidence w/Scleroderma (90%)
- Common in SLE & Sjogren syndrome (30%)
- May be assoc. w/drugs and trauma
A. Nicotine, caffeine, ergotamine
B. Vibrating tools (jackhammer)
What diagnostic tools are indicated for Reynaud’s disease?
- H & P
- Noninvasive vascular testing
- Screen for systemic disease
How is systemic disease screened for?
- ANA: antinuclear Antibody Test
A. If (+), specific serologic testing indicated
-Complement testing (↓ SLE), protein electrophoresis (↓ SLE), anti-Scl-70 (scleroderma), cryoglobulins (collagen vasc. Dz, MM)
How is Reynaud’s disease treated?
- Treat underlying auto immune disorder if (+)
- CCB’s effective
A. Nifedipine (Procardia) - Alpha blockers
A. Prazosin (Minipress), doxazosin (Cardura) - Nitrates
A. Nitropaste, hydralazine (Apresoline) - Avoid triggers
A. Cold temp, stress, smoking, caffeine, antihistamines, amphetamines, cocaine, beta-blockers, Estrogen Replacement Therapy
