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Temporal (Giant Cell) Arteritis (TA)
ILLUSTRATION: The disc is swollen with blurred margins. Hemorrhages are present inferiorly. The central cup is not visible. However, the disc is pale (ischemic) as opposed to other forms of disc swelling (optic neuritis, papilledema) which are more reddish in color with capillary congestion.
DISCUSSION: TA affects the elderly (over 50). All races are affected although it is more common in Scandinavian countries. Clinical features include headache, jaw claudication, scalp tenderness, polymyalgia rheumatica, fever, lethargy, tender temporal artery and severe vision loss. Diplopia (ocular muscle palsy), central and branch retinal artery occlusion may also be associated with TA. Lab studies include an elevated ESR, CRP and platelet count (15% may have a normal ESR). A positive TA biopsy establishes the definitive diagnosis.
Management is with immediate high dose steroids (60-80mg oral or intravenous methylprednisolone 1 gram per day for 3-5 days, then oral steroids). Treatment may be necessary for 1 - 2 years.
Steroids should be started on the high clinical suspicion of TA as the other eye frequently may become involved. Once vision is lost it is usually permanent. Treatment rarely helps the involved eye but is given to prevent the other eye from becoming involved.