Temporal Arteritis/ Giant Cell Arthritis

Question 1

What type of vasculitis is temporal artertisis?

Answer 1

A large vessel vasculitis.

Question 2

What other condition does temporal arteritis overlap with?

Answer 2

Polymyalgia rheumatica.

Question 3

Visual loss occurs in how many cases of temporal arteritis?

Answer 3

20%

Question 4

What are some features of temporal arteritis?

Answer 4

• Typically patient > 60 years old
• Usually rapid onset (e.g. < 1 month)
• Headache (found in 85%)
• Jaw claudication (65%)
• Visual disturbances secondary to anterior ischemic optic neuropathy
• Tender, palpable temporal artery
• Features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
• Also lethargy, depression, low-grade fever, anorexia, night sweats

Question 5

What blood tests should be done if temporal arteritis is suspected?

Answer 5

• ESR > 50mm/hr (Note ESR is <30 in 10% of patients)
• CRP may also be elevated.

NOTE: Creatine Kinase is usually normal.

Question 6

What is the investigation to diagnose temporal arteritis?

Answer 6

Temporal artery biopsy: skip lesions may be present.

Question 7

What is the treatment for temporal arteritis?

Answer 7

• High-dose prednisolone - there should be a dramatic response, if not the diagnosis should be reconsidered
  
  • 40 mg prednisolone daily unless the patient has ischaemic symptoms (jaw or tongue claudication, or visual symptoms).
  • Claudication symptoms: give 60 mg prednisolone daily.
  • If the patient has visual symptoms, admit for treatment with intravenous methylprednisolone.
  • Reducing regime: Once symptoms and abnormal test results resolve, the dose can be reduced in 10 mg steps each two weeks to 20 mg, then in 2.5 mg steps.
• Low Dose Aspirin - Low-dose aspirin has been shown to decrease the rate of visual loss and strokes in patients with GCA
  
  • Start aspirin 75 mg daily unless there are contra-indications - eg, active peptic ulceration or a bleeding disorder.
  • Start gastroprotection with a proton pump inhibitor in view of added risk of peptic ulceration with high-dose steroids and aspirin.
• Urgent ophthalmology review. Patients with visual symptoms should be seen the same-day by an ophthalmologist. Visual damage is often irreversible

Question 8

What does this show?

Answer 8

A pale and oedematous optic disc which is in keeping with an anterior ischemic optic neuropathy.

This is the usual type of finding in vision loss in temporal arteritis.