Temporal Arteritis

Question 1

What is the other name for temporal artheritis

Answer 1

Giant cell arteritis

Question 2

What is the other name for giant cell artertis

Answer 2

Temporal arteritis

Question 3

What is the meaning of arteritis

Answer 3

Refers to inflammation of the arteries

Question 4

What are the characteristics of temporal arteritis

Answer 4

Systemic immune mediated vasculitis characterised by granulomatous inflammation in the medium and large arteries.

Question 5

What artery is primarily affected in temporal/giant cell arteritis

Answer 5

Temporal arteries

Question 6

What is temporal/giant cell arteritis a medical emergency

Answer 6

Can quickly lead to visual loss

Question 7

What are the two main risk factors for temporal/giant cell arteritis

Answer 7

Female sex

Older age (>50)

Question 8

What causes temporal/giant cell arteritis to occur?

Answer 8

Exact cause remains unknown

Theorised that the condition is triggered by an environmental cause in a genetically predisposed person

Question 9

Name some of the clinical features of temporal/giant cell arteritis

Answer 9

In exam, patient typically has scalp tenderness, jaw claudication and “dark curtain descending vertically” visual changes

• Insidious onset of symptoms
• Unilateral temporal headache
• Jaw claudication (pain on chewing food)
• Visual disturbances
• Tender, palpable temporal artery
• Scalp tenderness (noticed when brushing hair)

Question 10

What is amaurosis fugax

Answer 10

transient monocular blindness, often described as a dark curtain descending vertically

A symptom of temporal/giant cell arteritis

Question 11

Temporal/giant cell arteritis often occur alongside another condition (50% of cases).

What is this other condition?

Answer 11

Polymyalgia rheumatica (PMR)

Question 12

Patients who have temporal arteritis and polymyalgia rheumatica (PMR) may present with features of PMR.

Name the two key features of PMR that a patient with temporal arteritis may present with

Answer 12

Symmetrical proximal muscle morning stiffness

Oligoarthritis (arthritis < 5 joints)

Question 13

Define Oligoarthritis

Answer 13

Arthritis in less than 5 joints

Question 14

Consider temporal arteritis in patients >50 who present with which 4 signs and symptoms?

Answer 14

New onset unilateral temporal headache

Jaw claudication

Acute visual symptoms

Unexplained raised inflammatory markers (CRP + ESR)

Question 15

What kind of headache is a clinical feature of temporal arteritis

Answer 15

Unilateral temporal headache

Question 16

Temporal arteritis has a low clinical suspicion.

Why is this?

Answer 16

Requires prompt treatment to prevent complications such as irreversible monocular blindness

Question 17

What are the two investigations that are used to give a definitive diagnosis of temporal arteritis

Answer 17

Vascular ultrasonography and/or artery biopsy

Question 18

What is the key feature of temporal arteritis on vascular ultrasonography

Answer 18

Halo sign

Question 19

Artery biopsy is a key component in the diagnosis of temporal arteritis.

What would the histology show?

Answer 19

Granulomatous inflammation, multinucleated giant cells with skip lesions (where the changes skip certain sections of the affected artery whilst damaging others)

Question 20

A negative artery biopsy does not rule out a diagnosis of temporal arteritis.

Why is that?

Answer 20

There are skip lesions present (where the changes skip certain sections of the affected artery whilst damaging others)

Question 21

Ophthalmic assessment can be used to investigate temporal arteritis.

What might this show?

Answer 21

Presence of a pale, swollen optic disc (sign of anterior ischaemic optic neuropathy)

Question 22

Describe how temporal arteritis can cause anterior ischaemic optic neuropathy

Answer 22

Anterior ischaemic optic neuropathy is when the optic nerve is damaged as result of insufficient blood supply (causing ischaemia). The insufficient blood supply can be a result of inflammation of the arteries (in temporal arteritis).

Vision in that eye is obscured by a dark shadow and there is no pain.

Question 23

Inflammatory markers may be used in investigating temporal arteritis.

When should they be taken?

Answer 23

Inflammatory markers (ESR and CRP) should be taken before starting high dose steroids as they decrease once steroids have started.

Do not wait for the test results before starting treatment for those who you have a strong suspicion of temporal arteritis

Question 24

What is the gold standard drug used in immediately in managing temporal arteritis

Answer 24

Oral Prednisolone (high dose glucocorticoid)

Question 25

Once symptoms of temporal arteritis have resolved, steroids should be gradually tapered.

Why must they be gradually tapered

Answer 25

Relapses can occur when tapering is too quick

Question 26

What other drug can be considering given alongside prednisolone in the management of temporal arteritis

Answer 26

Aspirin - used to prevent ischaemic complications

Question 27

Long-term glucocorticoids therapy should be prescribed alongside what 4 medications?

Answer 27

Bisphosphonates, calcium and vitamin D - prevent osteoporosis

PPI - prevent gastric ulcers

Question 28

Why are bisphosphonates and calcium and vitamin D prescribed when a patient is on long-term glucocorticoids

Answer 28

To prevent osteoporosis

Question 29

Why is a PPI prescribed when a patient is on long-term glucocorticoids

Answer 29

Prevention of gastric ulcers

Question 30

What are the 3 main complications of temporal arteritis if left untreated

Answer 30

Irreversible monocular blindness due to optic nerve ischaemia

Aortic aneurysm

Large vessel stenoses

Question 31

What type of blindness can temporal arteritis cause if not treated quick enough

Answer 31

Irreversible monocular blindness due to optic nerve ischaemia