TemporalArteritis in afya

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large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR). 
Histology shows changes which characteristically 'skips' certain sections of affected artery whilst damaging others.

''Features''
    typically patient > 60 years old
    usually rapid onset (e.g. < 1 month)
    headache (found in 85%)
    jaw claudication (65%)
    visual disturbances secondary to anterior ischemic optic neuropathy
    tender, palpable temporal artery
    features of PMR: aching, morning stiffness in proximal limb muscles (not weakness)
    also lethargy, depression, low-grade fever, anorexia, night sweats

''Investigations''
    raised inflammatory markers: ESR > 50 mm/hr (note ESR < 30 in 10% of patients). CRP may also be elevated
    temporal artery biopsy: skip lesions may be present
    note creatine kinase and EMG normal

''Treatment''
    high-dose prednisolone - there should be a dramatic response, if not the diagnosis should be reconsidered
    urgent ophthalmology review. Patients with visual symptoms should be seen the same-day by an ophthalmologist. Visual damage is often irreversible

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