Temporal Arteritis

1. Ade Wijaya, MD
February 2018
Giant Cell Arteritis

2. Outline:
 Introduction
 Epidemiology
 Clinical presentation
 Diagnosis
 Treatment
 Summary

3. Introduction
 Affects large and medium sized arteries, often
branches of the external carotid artery but also
the ciliary and retinal arteries
 Overlap with polymyalgia rheumatica
 Caused by local ischaemia due to endovascular
damage and cytokine mediated systemic illness.
 Often misdiagnosis
Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet 2008;372:234-45

4. Epidemiology
 Giant cell arteritis occurs in 2.2 per 10 000 patient
years in the United Kingdom
 One new case every 1-2 years
 Mean age of onset: 70
Hassan, N., Dasgupta, B., & Barraclough, K. (2011). Giant cell arteritis. BMJ: British Medical Journal, 342.
Meeth L, CookC, HallAJ. Incidence ofdiagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990 to 2001. AnnRheumDis 2006;65:1093-8

5. Clinical Presentation LR > 2
Jaw cludication
(34%)
Any
abnormality
of temporal
artery (65 %)
Diplopia
(8%)
Hassan, N., Dasgupta, B., & Barraclough, K. (2011). Giant cell arteritis. BMJ: British Medical Journal, 342.

6. Clinical Presentation LR > 1,5
Temporal
headche
ESR >
100
Scalp
tenderness
Anemia
Hassan, N., Dasgupta, B., & Barraclough, K. (2011). Giant cell arteritis. BMJ: British Medical Journal, 342.

7. Other symptoms
 Visual disturbances or visual loss
 Myalgia
 Low grade fever
 Weight loss
 Systemic malaise
Stberg G. Temporal arteritis in a large necropsy series. AnnRheumDis 1971;30:224-35.
Ezeonyeji AN, Borg FA, Dasgupta B. Delays in recognition and management of giant cell arteritis: results from a retrospective audit. ClinRheumatol 2011;30:259-62.
Meeth L, CookC, HallAJ. Incidence ofdiagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990 to 2001. AnnRheumDis 2006;65:1093-8

8. Diagnosis
 Clinical presentation
 Laboratory: raised LED > 100 mm/h; raised CRP
> 50 mm/h
 Temporal artery biopsy (sensitivity 87 %)
Iederkohr RD, Levin LA. A Bayesian analysis of the true sensitivity of a temporal Artery biopsy. InvestOpthalmol VisSci 2007;48:675-80.
Meeth L, CookC, HallAJ. Incidence ofdiagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990 to 2001. AnnRheumDis 2006;65:1093-8

9. Treatment
 w/o claudication symptoms : 40 mg prednisolone
 With claudication symptoms: 60 mg prednisolone
 Once symptoms and abnormal test results
resolve,
 The dose can be reduced in 10mg steps each
two weeks to 20 mg, then in 2.5 mg steps. Most
patients have stopped taking steroids by two
years
Asgupta B, Borg FA, Hassan N, Alexander L, Barraclough K, Bourke B, et al. BSR and BHPR guidelines for the management of giant cell arteritis. Rheumatology
2010;keq039a.

10. Summary
 Affect medium or large arteries
 Ischaemia, endovascular damage, and cytokine
mediated inflammation
 Elderly
 Classic triad: temporal headache, myalgia,
systemic malaise or fever
 Raised LED and CRP
 Th/ prednisolone

11. THANK YOU