Day #319 - Temporal Arteritis

From the JAMA series:

History:

• Jaw Claudication LR + 4.2 LR - 0.72
• Diplopia LR + 3.9 LR - 1

Other historical features not helpful to rule in or out. Most sensitive sign is headache (~70%) other signs and symptoms have sensitivity less that 50%

Physical:

• Beaded temporal artery LR + 4.6 LR - 0.9
• Prominant Temporal Artery LR + 4.3 LR - 0.7
• Tender Temporal Artery LR+ 2.6 LR - 0.8

Other physical exam findings are not helpful to rule in or rule out. Most sensitive is combination of ANY temporal artery abnormality (~75%)

Laboratory:

• Normal ESR LR - 0.2 (96% sensitive)

An review on the diagnosis and treatment of GCA/TA is available here. We discussed the relative merits of TA biopsy when the diagnosis is highly likely. The authors suggest that it is important to confirm the diagnosis because if negative, while it could still be TA, this should prompt a re-evaluation of the diagnosis as up to 50% will have an alternative diagnosis.

We then discussed the relative merits of TMP/SMX prophylaxis for PCP in patients on high dose steroids (Table below) from this meta-analysis. In general, though there is no consensus, PCP prophylaxis should be considered in patients on greater than 30mg of prednisone for greater than three months or those who are on moderate-high dose steroids with another immunosuppressive agent (i.e. patients with Wegner's)