Large VasculitiS****

Question 1

Giant cell (temporal) arteritis:

What is it?

What age group is it found in?

50% of patients have polymyalgia rheumatica. What is it?

Pain:

• Uni/bi
• Type of headache
• What would pain combing the hair indicate?
• What may happen in the jaw?
• 15% of patients get aortitis. How may it present?

Answer 1

Vasculitis of large and medium vessels in cranial branches of arteries arising from the aortic arch.

Elderly

A condition that causes pain, stiffness and inflammation in the MUSCLES around the shoulders, neck and hips.

Unilateral
Throbbing headache
Scalp tenderness

Jaw claudication - fatigue or discomfort of the jaw muscles during chewing of firm foods such as meat, chewing gum, or prolonged speaking.

Chest or abdo pain

Question 2

Giant cell (temporal) arteritis:

Other symptoms:

• Systemic symptoms - 2
• What symptoms may indicate polymyalgia rheumatica? - 2

Visual symptoms:

• Do you get pain?
• Uni/bi
• What is amaurosis fugax and what may it lead to?

Answer 2

Malaise
Fever

No
Unilateral but can be bilateral

Transient loss of vision initially but may be permanent as a complication.

Question 3

Giant cell (temporal) arteritis:

Signs:

• Where is tender?
• What may the pulse be like?
• What would the optic disc look like on fundoscopy?

Investigations:

• Bloods and why?
• What can be done to look for mononuclear/granulomatous infiltration when beginning Rx?

Management:

High dose PREDNISOLONE is used.

• How long are they on them for?
• What can be prescribed if the steroids are ineffective or causing side effects?
• What can be added to reduce the risk of stroke and visual loss?

Answer 3

Temporal artery over the temporal region

Weak or uneven temporal artery pulse

Inflammatory markers - ESR/CRP
FBC - high platelets and low Hb

6-12 months - taper off

Biologics - tocilizumab
Immunosuppressants - methotrexate

Aspirin

Question 4

Takayasu’s Arteritis:

What is it also called?

What artery does it affect?

What does it cause in the artery itself?

Answer 4

Aortic arch syndrome/ pulseless disease

Aorta

Granulomatous inflammation leads to stenosis and aneurysms

Question 5

Takayasu’s Arteritis:

What systemic symptoms do they have?

What happens to the pulses on each arm?

What arteries are bruits heard in?

What drug is used to treat it?

Answer 5

Fatigue 
Fever 
Weight loss 
Headache 
Myalgia 

Uneven, may be absent on one side

Carotid
Subclavian
Brachial
Abdominal aorta

Steroids (prednisolone) + methotrexate