Temporal Arteritis

Question 1

What is temporal arteritis also known as?

Answer 1

Giant cell arteritis

Question 2

What is temporal arteritis?

Answer 2

A granulomatous vasculitis of large and medium-sized arteries

Question 3

What arteries are primarily affected in temporal arteritis?

Answer 3

Branches of the external carotid artery

Question 4

How common is temporal arteritis as a vasculitis?

Answer 4

It is the most common form of systemic vasculitis in adults

Question 5

How does the pathology begin in temporal arteritis?

Answer 5

Dendritic cells in the vessel wall recruit T cells and macrophages to form granulomatous infiltrates

Question 6

What immune mediators and cells are involved in temporal arteritis?

Answer 6

• Th17 cells
• IL-6
• IL-17
• IL-21

Question 7

What can be used to suppress the inflammatory pathway in temporal arteritis?

Answer 7

Glucocorticoids

Question 8

What are the risk factors for temporal arteritis?

Answer 8

• Age >50
• Female
• Genetic factors
• Smoking
• Atherosclerosis
• Northern European

Question 9

Who should temporal arteritis be a differential in?

Answer 9

Anyone over 50 with headache, scalp tenderness, transient visual symptoms or unexplained facial pain

Question 10

Headache is a presenting symptom in what percentage of patients with temporal arteritis?

Answer 10

85%

Question 11

Where does the headache in temporal arteritis occur?

Answer 11

Temporal or occipital

Question 12

How bad is the headache in temporal arteritis?

Answer 12

Usually severe

Question 13

When may the headache in temporal arteritis be worse?

Answer 13

At night

Question 14

What other symptoms may be present in temporal arteritis?

Answer 14

• Jaw claudication
• Anorexia
• Weight loss
• Fever
• Malaise
• Sweats
• Fatigue
• Depression

Question 15

When may jaw claudication in temporal arteritis be prominent?

Answer 15

When talking or eating

Question 16

What cause visual disturbances in temporal arteritis?

Answer 16

Inflammation of the branches around the ophthalmic artery leading to ischaemic optic neuritis

Question 17

What visual disturbances may occur in temporal arteritis?

Answer 17

• Blurred vision
• Amaurosis fugax
• Transient or permanent visual loss
• Diplopia

Question 18

What signs may (but potentially not) be found in temporal arteritis?

Answer 18

• Abnormal palpation of the temporal artery
• Bruits over carotid/axillary/brachial arteries
• Tender muscles and joints
• Ocular and fundoscopic evidence of ischaemic neuritis

Question 19

What abnormalities may be felt on palpation of the temporal artery?

Answer 19

• Absent pulse
• Beaded
• Tender
• Enlarged

Question 20

What should patients with suspected temporal arteritis be referred urgently for?

Answer 20

Temporal artery biopsy

Question 21

When should temporal artery biopsy occur in temporal arteritis?

Answer 21

Within 2 weeks of starting steroids

Question 22

What findings can be seen on biochemistry in temporal arteritis?

Answer 22

• Elevated ESR and CRP
• Normocytic normochromic anaemia
• Thrombocytosis
• LFTs elevated

Question 23

What are the differentials for temporal arteritis?

Answer 23

• Migraine
• Tension headache
• Trigeminal neuralgia
• Takayasu’s arteritis
• Polyarteritis nodosa
• Polymyositis

Question 24

What are the three potential management options for temporal arteritis?

Answer 24

• Steroids
• Low-dose aspirin
• Tocilizumab

Question 25

When should steroids be started in temporal arteritis?

Answer 25

Once diagnosis is suspected

Question 26

What dose of steroids is given in temporal arteritis?

Answer 26

High dose

Question 27

What steroids should be given if there are no ischaemic or visual symptoms in temporal arteritis?

Answer 27

40mg prednisolone/day

Question 28

What is meant by 'ischaemic symptoms" in the treatment of temporal arteritis?

Answer 28

Jaw and tongue claudication

Question 29

If ischaemic symptoms in temporal arteritis are present what steroids should be given?

Answer 29

60mg prednisolone/day

Question 30

If there are visual symptoms present in temporal arteritis what steroids should be given?

Answer 30

Admission for IV methylprednisolone

Question 31

How should patients with settling symptoms of temporal arteritis be weened off steroids?

Answer 31

Reduce in 10mg steps/2 weeks to 20mg then in 2.5mg steps

Question 32

At what dose of steroids can flare-ups of temporal arteritis be usually controlled?

Answer 32

At the dose they were last previously controlled

Question 33

What dose of aspirin should be started in temporal arteritis?

Answer 33

75mg/day

Question 34

What contraindicates the starting of aspirin in temporal arteritis?

Answer 34

- Active peptic ulcer disease | - Bleeding disorders

Question 35

What is tocilizumab?

Answer 35

A novel biological agent with therapeutic and corticosteroid-sparing benefit for use in temporal arteritis

Question 36

What are the potential complications of temporal arteritis?

Answer 36

- Loss of vision - Aneurysms, dissections and stenotic lesions of the aorta and its branches - CNS disease - Steroid related complications

Question 37

What CNS complications can occur in temporal arteritis?

Answer 37

- Seizures - Cerebral vascular disease - Brain ischaemia

Question 38

What steroid-related complications can occur in temporal arteritis?

Answer 38

- Osteoporosis - Corticosteroid myopathy - Bruising - Emotional symptoms - Hypertension - Diabetes - Elevated cholesterol and fluid retention

Question 39

What 'emotional' steroid-related side effects can occur in temporal arteritis?

Answer 39

- Hypomania | - Depression