Temporal Arteritis Flashcards

1
Q

What is another term for temporal arteritis?

A

Giant cell arteritis (GCA)

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2
Q

What is temporal arteritis?

A

It is defined as a systemic vasculitis of medium and large arteries

It is a medical emergency, which requires prompt management in order to minimise complication risk – permanent vision loss

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3
Q

Which two arteries tend to be affected in temporal arteritis?

A

Extracranial branches the carotid artery

Ophthalmic artery

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4
Q

What are the four risk factors of temporal arteritis?

A

Older Age > 50 Years Old

Female Gender

White Race

Polymyalgia Rheumatica

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5
Q

What are the nine clincial features of temporal arteritis?

A

Severe Unilateral Temporal Headache

Scalp Tenderness

Jaw Claudication

Painless Vision Loss

Diplopia

Proximal Muscle Aches

Peripheral Oedema

Weight Loss

Reduced Temporal Artery Pulse

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6
Q

What is a red flag of temporal arteritis?

A

Scalp tenderness

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7
Q

What are the two situation in which scalp tenderness occurs in temporal arteritis?

A

Brushing hair

Resting head on pillow

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8
Q

What are the two situation in which jaw claudication occurs in temporal arteritis?

A

Talking

Chewing

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9
Q

What is the cause of visual clinical features in temporal arteritis?

A

Anterior ischaemic optic neuropathy

Specifically, there is occlusion of the posterior ciliary artery, which is a branch of the ophthalmic artery

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10
Q

What are the four investigations used to diagnose temporal arteritis?

A

Fundoscopy

Blood Tests

Ultrasound Scan

Temporal Artery Biopsy

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11
Q

What are the two features of temporal arteritis on fundoscopy?

A

Swollen Pale Optic Disc

Blurred Optic Disc Margins

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12
Q

What are the seven blood test results that indicate temporal arteritis?

A

Decreased RBC Levels

Normal MCV Size

Increased Platelet Levels

Increased ESR Levels > 50

Increased CRP Levels

Increased ALP Levels

Increased ALT Levels

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13
Q

What is a feature of temporal arteritis on ultrasound scans?

A

Halo sign

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14
Q

What is the halo sign?

A

It is defined as thickening of the affected blood vessel wall

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15
Q

What is the gold standard investigation used to diagnose temporal arteritis?

A

Temporal artery biopsy

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16
Q

What are the two features of temporal arteritis on temporal artery biopsy?

A

Multinucleated Giant Cells

Skip Lesions

17
Q

Why is a temporal artery biopsy not able to exclude a diagnosis? What should be conducted following a negative result, however positive clinical history?

A

A false negative result may be produced due to skip lesions

Therefore, we continue high dose prednisolone and repeat the biopsy

18
Q

What are the three immediate management options of temporal arteritis?

A

Urgent Referral

IV Corticosteroids

Oral Corticosteroids

19
Q

What referral should be conducted in all cases of temporal arteritis?

A

Urgent Rheumatology

20
Q

When should a same day opthamology referral be conducted in temporal arteritis?

A

In cases where there are vision clinical features

21
Q

When are IV corticosteroid used to manage temporal arteritis?

A

They should be administered in those with vision LOSS

22
Q

Name an IV corticosteroid used to manage temporal arteritis

A

IV methylprednisolone

23
Q

What dose of IV methyprednisolone is used to manage temporal arteritis?

A

500mg – 1g once daily for three consecutive days

24
Q

When are oral corticosteroids used to manage temporal arteritis?

A

A one-off high dose should be administered immeditely in those with visual feautres, prior to diagnosis confirmation with a temporal artery biopsy

A lower dose is then continued until clinical features have resolved

Once stable, the dose is gradually tapered over a period of 12 – 18 months

25
Q

Name an oral corticosteroid used to manage temporal arteritis

A

Oral Prednisolone

26
Q

What dose of oral prednisolone is used to immediatley manage temporal arteritis?

A

One off dose of 60mg - 100mg

27
Q

How is a one-off high dose of oral corticosteroids used to immediately manage temporal arteritis?

A

To reduce the risk of permanent vision loss

28
Q

What is the long term management option of temporal arteritis?

A

Oral corticosteroids

29
Q

What dose of oral prednisolone is used to manage temporal arteritis long term?

A

40 – 60 mg prednisolone once daily

30
Q

What two drugs are administered with long term corticosteroid use? Why?

A

Bisphosphonates, vitamin D supplements, calcium supplements - to prevent osteoporosis

Proton pump inhibitors - to prevent gastrointestinal bleeding

31
Q

What are the six complications of temporal arteritis?

A

Temporal Arteritis Relapse

Permanent Vision Loss

Stroke

Myocardial Infarction

Aortic Aneurysm

Aortic Dissection