Temporal arteritis
Temporal arteritis is large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR). Histology shows changes which characteristically 'skips' certain sections of affected artery whilst damaging others.
Features
Investigations
Treatment
Features
- 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
Investigations
- raised inflammatory markers: ESR > 50 mm/hr (note ESR < 30 in 10% of patients). CRP may also be elevated
- temporal artery biopsy: skip lesions may be present
- note creatine kinase and EMG normal
Treatment
- high-dose prednisolone - there should be a dramatic response, if not the diagnosis should be reconsidered
- urgent ophthalmology review. Patients with visual symptoms should be seen the same-day by an ophthalmologist. Visual damage is often irreversible