Granulomatous large-vessel vasculitis of the aorta and its cranial branches in patients over 50.
Clinical features
- • New temporal headache
- • Jaw claudication
- • Scalp tenderness
- • Visual loss or amaurosis fugax
- • Polymyalgic shoulder/hip girdle pain
Investigations
- • ESR/CRP (usually markedly raised)
- • Temporal artery ultrasound (halo sign) within 7 days
- • Temporal artery biopsy within 2 weeks — skip lesions possible
- • PET-CT if large-vessel disease suspected
Management
- • Do NOT wait for biopsy — start prednisolone 40–60 mg immediately
- • IV methylprednisolone 500–1000 mg for visual symptoms
- • Tocilizumab as steroid-sparing agent
- • Bone and gastric protection, glucose monitoring
Complications
- • Irreversible blindness
- • Aortic aneurysm/dissection
- • Steroid morbidity
Clinical pearls
- • Visual loss in one eye predicts fellow-eye involvement within days if untreated
Related in WardRound
Educational — verify locally.
