Temporal arteritis

Temporal arteritis - Chronic

 

Definition  

An immune mediated disease characterized by systemic, inflammatory vasculitis involving medium- and large-sized arteries, primarily cranial branches of arteries originating from the arch of the aorta .

 

Medical History  

* Generalized atherosclerosis

* Family history of Temporal arteritis

* Anticardiolipin antibodies positive

* Smoking

* Environmental Exposure

 

Findings  

* Absent pulse

* Chest pain

* Diplopia

* Pain in face

* Arthralgia

* Confusion

* Cough

* Edema

* Erythema

* Headache

* Increased body temperature

* Induration of skin

* Jaw pain

* Joint stiffness

* Loss of appetite

* Malaise

* Myalgia

* Night sweats

* Tenderness

 

Tests  

 

Suspected giant cell (temporal) arteritis  

* Erythrocyte sedimentation rate measurement: Erythrocyte sedimentation rate is elevated in most, but not all, patients with giant cell arteritis; a normal result does not exclude disease .

 

Suspected giant cell (temporal) arteritis  

* Biopsy of temporal artery: Typically panarteritis, with lymphocytes and macrophages in the media and media-intima junction, is found; giant cells are found in 50% of patients .

 

Evaluation of suspected giant cell (temporal) arteritis  

* C-reactive protein measurement

 

Suspected giant cell (temporal) arteritis  

* Platelet count: Thrombocytosis is an important marker for giant cell (temporal) arteritis in a patient not receiving corticosteroids .

 

Suspected or known giant cell (temporal) arteritis  

* Arteriography: Arteriogram in large-vessel giant cell arteritis may show bilateral stenosis or occlusion of the subclavian, axillary, and/or proximal brachial arteries .

 

Differential Diagnosis  

* Giant cell arteritis

* Temporal arteritis

* Systemic inflammatory response syndrome

* Aortitis

* Polymyalgia rheumatica - Acute

* Polyarteritis nodosa

* Generalized atherosclerosis

* Takayasu's disease

* Migraine - Acute

* Meningitis

* Amyloidosis

 

Treatment  

 

Drug Therapy  

 

 

Suspected and known giant cell (temporal) arteritis  

 

PREDNISONE  

Adults: Initial dose of 1 mg/kg body weight orally in single or divided doses

 

METHYLPREDNISOLONE  

Adults: 250 mg IV every 6 hours for 3 to 5 days followed by oral corticosteroid therapy