TEMPORAL GIANT CELL ARTERITIS—CRANIAL ARTERITIS, GRANULOMATOUS ARTERITIS
A H&N VASCULITIS
50% COMORBID WITH PMR (POLYMYALGIA RHEUMATICA)—-PMR IS 2-3X MORE COMMON—-MUSCULOSKELETAL PAIN IN NECK, SHOULDERS, PELVIS ECT.
ANEMIA, DEPRESSION, WT LOSS, AM STIFFNESS, FATIGUE, LOW GRADE FEVER, MALAISE FOR GREATER THAN 1 MONTH
TEMPORAL ARTERITIS = A COMMON IDIOPATHIC SMOALL VESSEL VASCULITIS—-RESULTANT ISCHEMIA
FEMALE > MALE
90% > 60
90% UNILATERAL?/BILATERAL?
HA–INTENSE PULSATILE CEPHALALGIA, HYPERALGESIA OF THE SCALP, JAWS, TONGUE, AND NECK—MASTICATORY CLAUDICATION, ODYNOPHONIA, ANOREXIA, MALAISE, FEVER, ½ OF THE TIME WILL HAVE STREAKING ERYTHEMA OVER THE TEMPPORAL ARTERY
ESR > 40—OFTEN >100
LOW ALBUMIN AND HIGH IMMUNOGLOBULIN COUNTS
1/3 PTS HAVE OPHTHO INVOLVEMENT
BLINDNESS IN 1/3 OF UNTREATED PTS—OFTEN HERALDED BY AMAUROSIS FUGAX
IF SUSPICIOUS—START STEROIDS—60MG IV
NEED TO DO TEMPORAL ARTERY BIOPSY WITHIN 72 HOURS OF STARTING STEROIDS—TAKE 6 CM SEGMENT USUALLY OF THE POST BRANCH (SKIP LESIONS–A 30% INCIDENCE)—-DO NOT INJECT WITH EPI OR YOU MAY LOSE PULSATIONS TO GUIDE THE DISSECTION—-CAN USE DOPPLER IF YOU WANT
IF BIOPSY NEGATIVE GO TO THE OTHER SIDE
MAY NEED TO TREAT WITH STEROIDS UP TO 2 YEARS——-NEVER MISDIAGNOSE AS MIGRAINE AND NEVER TREAT WITH ERGOTAMINES—-CAN QUICKLY GO BLIND