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| ==Background==
| | #REDIRECT[[Giant cell arteritis]] |
| *Systemic vasculitis most commonly involving medium-sized arteries in the carotid circulation affection 1% of the population<ref>Gonzalez-Gay, MA et al. Epidemiology of the vasculitides. Rheum Dis Clin North Am. 2001;27:729-749</ref>
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| *Giant cell arteritis, with possible involvement of large vessels like aorta leading to<ref>Morabito GC, Tartaglino B. Chapter 279. Emergencies in Systemic Rheumatic Diseases. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hil</ref>:
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| **[[Aortic regurgitation]]
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| **Aortic arch syndrome
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| **[[Aortic dissection]]
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| *Elevated risk in Women and 50-70 yrs of age
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| *"Rule of 50s" can help remember useful points - "temporal arteritis affects patients at least 50 years of age, with a serum ESR > 50 mm/hr and is treated with 50mg of prednisone daily"
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| *Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated
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| *Associated with [[polymyalgia rheumatica]] (30-40%)<ref> Lehrmann JF, Sercombe CT: Systemic Lupus Erythmatosus and the Vasculitides, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 116: p 1497-1510.</ref>
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| ==Clinical Features==
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| *[[Fever]]
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| *[[Headache]] in 85%
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| **Gradually worsens over days
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| **Worse at night
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| **Usually unilateral near temple
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| *Jaw claudication
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| **Weight Loss
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| *Myalgias
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| *Visual loss in one eye in 50%
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| **Posterior ciliary artery
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| **May present as amaurosis fugax
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| **Second eye may be affected within weeks after first
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| ===American College of Rheumatology Criteria<ref>Hunder GG. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8):1122-8 </ref>===
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| *3 or more criteria 93% sensitive and 91% specific
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| **Age ≥ 50 years old
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| **New onset of headache
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| **Temporal artery tenderness or DECREASED temporal pulse (not related to carotid disease)
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| **ESR ≥ 50 mm/hr
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| **Artery biopsy with necrotizing arteritis or a granulomatous process with multinucleated giant cells
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| ==Differential Diagnosis==
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| {{Headache DDX}}
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| {{Acute vision loss noninflamed DDX}}
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| {{Primary Vasculitis DDX}}
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| ==Diagnosis==
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| *Temporal artery tenderness
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| *Afferent pupillary defect
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| *Pale and edematous optic disc
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| *ESR ~70-110
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| **84% sensitivity, 30% specificity<ref>Kermani TA, et al. Utility of erythrocyte sedimentation rate and C-reactive protein for the diagnosis of giant cell arteritis. Semin Arthritis Rheum. 2012; 41:866–871.</ref>
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| **>15% of patients can have a normal ESR
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| *CRP elevated
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| *4% of patients have normal CRP and ESR with biopsy confirmed dx<ref>Jhun P, et al. Giant Cell Arteritis: Read the Fine Print! Ann Em Med. 2015; 65(5):615–617.</ref>
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| ==Management==
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| *[[Methylprednisolone]] 1000mg IV QD x3d
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| *Needs temporal artery biopsy
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| ==Disposition==
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| *Admission
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| ==See Also==
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| *[[Headache]]
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| ==References==
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| <references/>
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| [[Category:Ophthalmology]]
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| [[Category:Neurology]]
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| [[Category:Rheumatology]]
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