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GIANT CELL ARTERITIS (temporal arteritis) (SYMPTOMS (EXTRACRANIAL SYMPTOMS…
GIANT CELL ARTERITIS (temporal arteritis)
Common in the elderly—consider Takayasu’s if under 55yrs
Associated with pmr in 50%
SYMPTOMS
sudden unilateral blindness
EXTRACRANIAL SYMPTOMS
Malaise
dyspnoea
weight loss
morning stiffness
unequal or weak pulses
amaurosis fugax
tongue/jaw claudication
temporal artery and scalp tenderness (eg when combing hair)
The risk is irreversible bilateral visual loss, which can occur suddenly if not treated
Headache
TESTS
inc ALP
dec Hb
inc platelet
Temporal artery biopsy within 14 days of starting steroids or fdg-pet
ESR & CRP inc
Skip lesions occur, so don’t be put off by a negative biopsy (up to 10%)
MANAGEMENT
Start prednisolone 60mg/d po immediately
IV methylprednisolone if evolving visual loss or history of amaurosis fugax
PROGNOSIS
Typically a 2-year course, then complete remission.
Reduce prednisolone once symptoms have resolved and ↓esr
↑dose if symptoms recur
Main cause of death and morbidity in gca is long-term steroid treatment so balance risks!
Give ppi, bisphosphonate, calcium with colecalciferol, and consider aspirin