Temporal Arteritis Flashcards
What is the other name for temporal artheritis
Giant cell arteritis
What is the other name for giant cell artertis
Temporal arteritis
What is the meaning of arteritis
Refers to inflammation of the arteries
What are the characteristics of temporal arteritis
Systemic immune mediated vasculitis characterised by granulomatous inflammation in the medium and large arteries.
What artery is primarily affected in temporal/giant cell arteritis
Temporal arteries
What is temporal/giant cell arteritis a medical emergency
Can quickly lead to visual loss
What are the two main risk factors for temporal/giant cell arteritis
Female sex
Older age (>50)
What causes temporal/giant cell arteritis to occur?
Exact cause remains unknown
Theorised that the condition is triggered by an environmental cause in a genetically predisposed person
Name some of the clinical features of temporal/giant cell arteritis
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)
What is amaurosis fugax
transient monocular blindness, often described as a dark curtain descending vertically
A symptom of temporal/giant cell arteritis
Temporal/giant cell arteritis often occur alongside another condition (50% of cases).
What is this other condition?
Polymyalgia rheumatica (PMR)
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
Symmetrical proximal muscle morning stiffness
Oligoarthritis (arthritis < 5 joints)
Define Oligoarthritis
Arthritis in less than 5 joints
Consider temporal arteritis in patients >50 who present with which 4 signs and symptoms?
New onset unilateral temporal headache
Jaw claudication
Acute visual symptoms
Unexplained raised inflammatory markers (CRP + ESR)
What kind of headache is a clinical feature of temporal arteritis
Unilateral temporal headache
Temporal arteritis has a low clinical suspicion.
Why is this?
Requires prompt treatment to prevent complications such as irreversible monocular blindness
What are the two investigations that are used to give a definitive diagnosis of temporal arteritis
Vascular ultrasonography and/or artery biopsy
What is the key feature of temporal arteritis on vascular ultrasonography
Halo sign
Artery biopsy is a key component in the diagnosis of temporal arteritis.
What would the histology show?
Granulomatous inflammation, multinucleated giant cells with skip lesions (where the changes skip certain sections of the affected artery whilst damaging others)
A negative artery biopsy does not rule out a diagnosis of temporal arteritis.
Why is that?
There are skip lesions present (where the changes skip certain sections of the affected artery whilst damaging others)
Ophthalmic assessment can be used to investigate temporal arteritis.
What might this show?
Presence of a pale, swollen optic disc (sign of anterior ischaemic optic neuropathy)
Describe how temporal arteritis can cause anterior ischaemic optic neuropathy
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.
Inflammatory markers may be used in investigating temporal arteritis.
When should they be taken?
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
What is the gold standard drug used in immediately in managing temporal arteritis
Oral Prednisolone (high dose glucocorticoid)
Once symptoms of temporal arteritis have resolved, steroids should be gradually tapered.
Why must they be gradually tapered
Relapses can occur when tapering is too quick
What other drug can be considering given alongside prednisolone in the management of temporal arteritis
Aspirin - used to prevent ischaemic complications
Long-term glucocorticoids therapy should be prescribed alongside what 4 medications?
Bisphosphonates, calcium and vitamin D - prevent osteoporosis
PPI - prevent gastric ulcers
Why are bisphosphonates and calcium and vitamin D prescribed when a patient is on long-term glucocorticoids
To prevent osteoporosis
Why is a PPI prescribed when a patient is on long-term glucocorticoids
Prevention of gastric ulcers
What are the 3 main complications of temporal arteritis if left untreated
Irreversible monocular blindness due to optic nerve ischaemia
Aortic aneurysm
Large vessel stenoses
What type of blindness can temporal arteritis cause if not treated quick enough
Irreversible monocular blindness due to optic nerve ischaemia
