Temporal Arteritis Flashcards
What is another term for temporal arteritis?
Giant cell arteritis (GCA)
What is temporal arteritis?
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
Which two arteries tend to be affected in temporal arteritis?
Extracranial branches the carotid artery
Ophthalmic artery
What are the four risk factors of temporal arteritis?
Older Age > 50 Years Old
Female Gender
White Race
Polymyalgia Rheumatica
What are the nine clincial features of temporal arteritis?
Severe Unilateral Temporal Headache
Scalp Tenderness
Jaw Claudication
Painless Vision Loss
Diplopia
Proximal Muscle Aches
Peripheral Oedema
Weight Loss
Reduced Temporal Artery Pulse
What is a red flag of temporal arteritis?
Scalp tenderness
What are the two situation in which scalp tenderness occurs in temporal arteritis?
Brushing hair
Resting head on pillow
What are the two situation in which jaw claudication occurs in temporal arteritis?
Talking
Chewing
What is the cause of visual clinical features in temporal arteritis?
Anterior ischaemic optic neuropathy
Specifically, there is occlusion of the posterior ciliary artery, which is a branch of the ophthalmic artery
What are the four investigations used to diagnose temporal arteritis?
Fundoscopy
Blood Tests
Ultrasound Scan
Temporal Artery Biopsy
What are the two features of temporal arteritis on fundoscopy?
Swollen Pale Optic Disc
Blurred Optic Disc Margins
What are the seven blood test results that indicate temporal arteritis?
Decreased RBC Levels
Normal MCV Size
Increased Platelet Levels
Increased ESR Levels > 50
Increased CRP Levels
Increased ALP Levels
Increased ALT Levels
What is a feature of temporal arteritis on ultrasound scans?
Halo sign
What is the halo sign?
It is defined as thickening of the affected blood vessel wall
What is the gold standard investigation used to diagnose temporal arteritis?
Temporal artery biopsy
What are the two features of temporal arteritis on temporal artery biopsy?
Multinucleated Giant Cells
Skip Lesions
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 false negative result may be produced due to skip lesions
Therefore, we continue high dose prednisolone and repeat the biopsy
What are the three immediate management options of temporal arteritis?
Urgent Referral
IV Corticosteroids
Oral Corticosteroids
What referral should be conducted in all cases of temporal arteritis?
Urgent Rheumatology
When should a same day opthamology referral be conducted in temporal arteritis?
In cases where there are vision clinical features
When are IV corticosteroid used to manage temporal arteritis?
They should be administered in those with vision LOSS
Name an IV corticosteroid used to manage temporal arteritis
IV methylprednisolone
What dose of IV methyprednisolone is used to manage temporal arteritis?
500mg – 1g once daily for three consecutive days
When are oral corticosteroids used to manage temporal arteritis?
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
Name an oral corticosteroid used to manage temporal arteritis
Oral Prednisolone
What dose of oral prednisolone is used to immediatley manage temporal arteritis?
One off dose of 60mg - 100mg
How is a one-off high dose of oral corticosteroids used to immediately manage temporal arteritis?
To reduce the risk of permanent vision loss
What is the long term management option of temporal arteritis?
Oral corticosteroids
What dose of oral prednisolone is used to manage temporal arteritis long term?
40 – 60 mg prednisolone once daily
What two drugs are administered with long term corticosteroid use? Why?
Bisphosphonates, vitamin D supplements, calcium supplements - to prevent osteoporosis
Proton pump inhibitors - to prevent gastrointestinal bleeding
What are the six complications of temporal arteritis?
Temporal Arteritis Relapse
Permanent Vision Loss
Stroke
Myocardial Infarction
Aortic Aneurysm
Aortic Dissection
