Temporal arteritis

Question 1

Presentation of temporal arteritis?

Answer 1

50+ (usually over 60 in 90% cases)
Symptoms present rapidly
Headache over temples - tenderness, palpable temporal artery. Headache is unilateral.
Jaw claudication during mastication- so also have weight loss
Visual disturbances present
—> amaurosis fugal
—> diplopia
—> blurred vision
—> blindness - hopefully see them before this
Scalp tenderness

Features of PMR - aching in shoulder and hip girdles. Morning STIFFNESS - not weakness.

Vague symptoms may present - lethargy, depression, low-grade fever, anorexia, night sweats.

Question 2

Investigations for temporal arteritis?
What would results for these inv be?

Answer 2

ESR —> would be high >50 mm/hr
CRP —> high
Temporal artery biopsy —> show skip lesions
CK —> normal

Question 3

Management of temporal arteritis?

Answer 3

Urgent high dose prednisolone 60-100mg for at least two weeks. Can give Methylpred IV for 1-3 days if visual loss is present - give before the biopsy. Give if suspected GCA

Urgent Optham review

Bone protection with bisphosphonates for long term steroid use

Low dose aspirin therapy to reduce thrombotic risks.

Question 4

Risk factors for temporal arteritis?

Answer 4

Age over 50
PMR Hx
Genetic - HLA DR4
White

Question 5

How is GCA Dx made? (Rheum revision)

Answer 5

Presence of 2 or more of the following in pts who are 50+:
- Raised ESR, CRP or PV
- new onset of localised headache
- tenderness or decreased pulsation of temporal artery
- new visual Sx
- biopsy shows necrotising arteritis

Question 6

Ddx for temporal arteritis?

Answer 6

PMR
Solid organ cancers
Chronic infection
Takayasu’s Arteritis
RA
SLE