Difference between revisions of "Giant cell arteritis"

(Redirected page to Temporal arteritis)
 
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#REDIRECT[[Temporal arteritis]]
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==Background==
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*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]]

Revision as of 18:01, 25 March 2016

Background

  • Systemic vasculitis most commonly involving medium-sized arteries in the carotid circulation affection 1% of the population[1]
  • Giant cell arteritis, with possible involvement of large vessels like aorta leading to[2]:
  • Elevated risk in Women and 50-70 yrs of age
  • "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"
  • Can cause painless, ischemic optic neuropathy w/ severe vision loss if left untreated
  • Associated with polymyalgia rheumatica (30-40%)[3]

Clinical Features

  • Fever
  • Headache in 85%
    • Gradually worsens over days
    • Worse at night
    • Usually unilateral near temple
  • Jaw claudication
    • Weight Loss
  • Myalgias
  • Visual loss in one eye in 50%
    • Posterior ciliary artery
    • May present as amaurosis fugax
    • Second eye may be affected within weeks after first

American College of Rheumatology Criteria[4]

  • 3 or more criteria 93% sensitive and 91% specific
    • Age ≥ 50 years old
    • New onset of headache
    • Temporal artery tenderness or DECREASED temporal pulse (not related to carotid disease)
    • ESR ≥ 50 mm/hr
    • Artery biopsy with necrotizing arteritis or a granulomatous process with multinucleated giant cells

Differential Diagnosis

Headache

Common

Killers

Maimers

Others

Aseptic Meningitis

Acute Vision Loss (Noninflamed)

Emergent Diagnosis

Diagnosis

  • Temporal artery tenderness
  • Afferent pupillary defect
  • Pale and edematous optic disc
  • ESR ~70-110
    • 84% sensitivity, 30% specificity[5]
    • >15% of patients can have a normal ESR
  • CRP elevated
  • 4% of patients have normal CRP and ESR with biopsy confirmed dx[6]

Management

Disposition

  • Admission

See Also

References

  1. Gonzalez-Gay, MA et al. Epidemiology of the vasculitides. Rheum Dis Clin North Am. 2001;27:729-749
  2. 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
  3. 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.
  4. Hunder GG. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis. Arthritis Rheum. 1990; 33(8):1122-8
  5. 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.
  6. Jhun P, et al. Giant Cell Arteritis: Read the Fine Print! Ann Em Med. 2015; 65(5):615–617.