Temporal Arteritis

Question 1

what is temporal arteritis?

Answer 1

large-vessel vasculitis
overlaps with pmr

Question 2

histology of temporal arteritis?

Answer 2

skip lesions in affected artery

Question 3

features of temporal arteritis?

Answer 3

usually > 60
rapid onset usually < 1 mo
headache
jaw claudication
vision abnormalities
tender, palpable temporal artery

lethargy, depression, low-grade fever, anorexia, night sweats
features of pMR

Question 4

what featurse of PMR may be seen in temporal arteritis?

Answer 4

aching
morning stiffness in proximal limb muscles (NOT WEAKNESS)

Question 5

what visual abnormalities may be seen in temporal arteritis?

Answer 5

anterior ischaemic optic neuropathy - most common (due to occlusion of posterior ciliary artery, a br of ophthalmic) -> ischaemic on head
fundoscopy would show swollen pale disc + blurred margins

maybe temporary visual loss - amaurosis fugax

permanent visual loss - may develop suddenly

diplopia if any part of oculomotor system is involved

Question 6

ix of temporal arteritis?

Answer 6

raised inflammatory markers - esr > 50 mm/hr, crp maybe elevated
temporal artery biopsy - skip lesions

CK and EMG normal

Question 7

tx of temporal arteritis

Answer 7

urgent high-dose glucocorticoids as soon as ?TA and BEFORE temporal artery biopsy
- no visual loss: high-dose prednisolone
- evolving visual loss: IV methylprednisolone before high-dose prednisolone

if no dramatic improvement then reconsider dx

urgent optho review (same day) - visual damage is irreversible

other tx: bone protection for as long as steroids used + low-dose aspiring sometimes

Question 8

typical prednisolone dose for temporal arteritis?

Answer 8

high dose, so 60mg OD