Temporal Arteritis Flashcards
What is temporal arteritis also known as?
Giant cell arteritis
What is temporal arteritis?
A granulomatous vasculitis of large and medium-sized arteries
What arteries are primarily affected in temporal arteritis?
Branches of the external carotid artery
How common is temporal arteritis as a vasculitis?
It is the most common form of systemic vasculitis in adults
How does the pathology begin in temporal arteritis?
Dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates
What immune mediators and cells are involved in temporal arteritis?
- Th17 cells
- IL-6
- IL-17
- IL-21
What can be used to suppress the inflammatory pathway in temporal arteritis?
Glucocorticoids
What are the risk factors for temporal arteritis?
- Age >50
- Female
- Genetic factors
- Smoking
- Atherosclerosis
- Northern European
Who should temporal arteritis be a differential in?
Anyone over 50 with headache, scalp tenderness, transient visual symptoms or unexplained facial pain
Headache is a presenting symptom in what percentage of patients with temporal arteritis?
85%
Where does the headache in temporal arteritis occur?
Temporal or occipital
How bad is the headache in temporal arteritis?
Usually severe
When may the headache in temporal arteritis be worse?
At night
What other symptoms may be present in temporal arteritis?
- Jaw claudication
- Anorexia
- Weight loss
- Fever
- Malaise
- Sweats
- Fatigue
- Depression
When may jaw claudication in temporal arteritis be prominent?
When talking or eating
What cause visual disturbances in temporal arteritis?
Inflammation of the branches around the ophthalmic artery leading to ischaemic optic neuritis
What visual disturbances may occur in temporal arteritis?
- Blurred vision
- Amaurosis fugax
- Transient or permanent visual loss
- Diplopia
What signs may (but potentially not) be found in temporal arteritis?
- Abnormal palpation of the temporal artery
- Bruits over carotid/axillary/brachial arteries
- Tender muscles and joints
- Ocular and fundoscopic evidence of ischaemic neuritis
What abnormalities may be felt on palpation of the temporal artery?
- Absent pulse
- Beaded
- Tender
- Enlarged
What should patients with suspected temporal arteritis be referred urgently for?
Temporal artery biopsy
When should temporal artery biopsy occur in temporal arteritis?
Within 2 weeks of starting steroids
What findings can be seen on biochemistry in temporal arteritis?
- Elevated ESR and CRP
- Normocytic normochromic anaemia
- Thrombocytosis
- LFTs elevated
What are the differentials for temporal arteritis?
- Migraine
- Tension headache
- Trigeminal neuralgia
- Takayasu’s arteritis
- Polyarteritis nodosa
- Polymyositis
What are the three potential management options for temporal arteritis?
- Steroids
- Low-dose aspirin
- Tocilizumab
When should steroids be started in temporal arteritis?
Once diagnosis is suspected
What dose of steroids is given in temporal arteritis?
High dose
What steroids should be given if there are no ischaemic or visual symptoms in temporal arteritis?
40mg prednisolone/day
What is meant by ‘ischaemic symptoms” in the treatment of temporal arteritis?
Jaw and tongue claudication
If ischaemic symptoms in temporal arteritis are present what steroids should be given?
60mg prednisolone/day
If there are visual symptoms present in temporal arteritis what steroids should be given?
Admission for IV methylprednisolone
How should patients with settling symptoms of temporal arteritis be weened off steroids?
Reduce in 10mg steps/2 weeks to 20mg then in 2.5mg steps
At what dose of steroids can flare-ups of temporal arteritis be usually controlled?
At the dose they were last previously controlled
What dose of aspirin should be started in temporal arteritis?
75mg/day
What contraindicates the starting of aspirin in temporal arteritis?
- Active peptic ulcer disease
- Bleeding disorders
What is tocilizumab?
A novel biological agent with therapeutic and corticosteroid-sparing benefit for use in temporal arteritis
What are the potential complications of temporal arteritis?
- Loss of vision
- Aneurysms, dissections and stenotic lesions of the aorta and its branches
- CNS disease
- Steroid related complications
What CNS complications can occur in temporal arteritis?
- Seizures
- Cerebral vascular disease
- Brain ischaemia
What steroid-related complications can occur in temporal arteritis?
- Osteoporosis
- Corticosteroid myopathy
- Bruising
- Emotional symptoms
- Hypertension
- Diabetes
- Elevated cholesterol and fluid retention
What ‘emotional’ steroid-related side effects can occur in temporal arteritis?
- Hypomania
- Depression
