- Rare under 50
- Generalised headaches
- Scalp tenderness
- Claudication of the jaw
- Painless temporary or permanent visual loss – if more than one of the occipital or temporal arteries is affected.
- Generalised malaise
- Normocytic / normochromic anaemia
- Low albumin
Temporal arterial biopsy
- This is the definitive diagnostic test. You need to take the sample before or within 7 days of starting steroids (if these are given)
- Histological features include:
- Intimal hypertrophy
- Inflammation of the intima
- Degredation of the internal elastic lamina
- Giant cells, lymphocytes and plasma cells in the internal elastic lamina
Corticosteroids – 60-100mg prednisolone/day, in divided doses.– this can dramatically reduce symptoms within 24 hours. Treatment with corticosteroids once the diagnosis is made is compulsory! – it greatly reduces the risk of visual loss. It is best to start with a higher dose and gradually reduce it.
- The disease is likely to settle after 12-36 months of treatment in 75% of cases. In the remaining 25%, low dose corticosteroids may be needed for years.
- Calcium and vit D supplements should be given to avoid osteoporosis whilst on steroids.
- Consider PPI for gastric protection if patient is at increased risk of GI bleeding or dyspepsia
NSAID’s should not be used.