Temporal arteritis

Question 1

What are the visual changes that arise in temporal arteritis?

Answer 1

diplopia
visual field defects
changes to colour vision 
a feeling of 'shade' covering one eye
painless!!

Question 2

What is temporal arteritis?

Answer 2

systemic vasculitis affecting both large and medium sized vessels

Question 3

Branches from which artery are associated with temporal arteritis?

Answer 3

extracranial branches of carotid artery

Question 4

Which condition is associated with temporal arteritis?

Answer 4

polymyalgia rheumatica

Question 5

Name two risk factors for polymyalgia rheumatica?

Answer 5

female, >50

Question 6

What are typical symptoms of temporal arteritis?

Answer 6

new onset unilateral headache in temporal region
systemic features e.g. weight loss fever
scalp tenderness
eye symptoms
temporal artery tenderness/thickening/nodularity
neurological features

Question 7

Investigations for temporal arteritis?

Answer 7

ESR CRP
LFTs
FBC- normochromic normocytic anaemia, increased platelet count
temporal artery USS + biopsy

Question 8

What features of temporal artery USS is typical of temporal arteritis?

Answer 8

halo sign= thickening of wall

Question 9

Which changes can be seen in temporal arteritis biopsy?

Answer 9

mononuclear cell infiltration or granulomatour inflammation

Question 10

What is the management of temporal arteritis?

Answer 10

oral pred

Question 11

Three symptoms/signs of GCA/temporal arteritis?

Answer 11

 Systemic signs: fever, malaise, fatigue
 Headache
 Temporal artery and scalp tenderness
 Jaw claudication
 Amaurosis fugax
 Prominent temporal arteries ± pulsation
Polymyalgia rheumatica

Question 12

What is a key histological feature of giant cell arteritis? = temporal arteritis

Answer 12

multinucleated giant cells

Question 13

Which arteries does giant cell arteritis typically affect?

Answer 13

aorta and its major branches

Question 14

Describe two features of the headache that presents in GCA

Answer 14

temporal headache (affecting temporal artery) with tenderness, subacute onsent, constant, little relief with analgesics

Question 15

Which symptom is almost always associated with giant cell arteritis?

Answer 15

jaw claudication- due to ischaemia of maxillary artery supplying masseter muscles

Question 16

Two complications of GCA?

Answer 16

1. Visual loss- acute ischaemic optic neuropathy 2. Large vessel vasculitis- aortic aneurysm 3. CVA/stroke (cerebrovascular accident)

Question 17

How is GCA diagnosed?

Answer 17

1. Clinical presentation 2. Clinical examination findings- temporal artery thickening, tenderness, loss of pulsality 3. Biopsy

Question 18

What is the gold standard of making GCA diagnosis?

Answer 18

temporal artery biopsy

Question 19

If you have strong suspicion of GCA but have not yet received results of investigations, should you treat?

Answer 19

YES, as patient could go blind overnight!

Question 20

What is the treatment for GCA?

Answer 20

prednisolone (steroids) and aspirin (balance of other conditions, e.g. if patient has peptic ulcer disease then avoid aspirin)

Question 21

Which arteries can be affected in GCA?

Answer 21

opthalmic
temporal
occipital

Question 22

How can polymyositis be distinguished from GCA biochemically?

Answer 22

CK raised excessively in polymyositis whilst normal in GCA