Temporal Arteritis – Pulling Out All The Stops

Rahul Dubey MBBS (Hons) MMed^1,2
Gaurav Bhardwaj MBBCh^1,2
Freny Kalapesi FRANZCO^1,2
Ian C. Francis1 FASOPRS, PhD^1,2

¹Prince of Wales Hospital, Sydney, Australia
²University of NSW, Sydney, Australia

Purpose: Temporal arteritis (TA) is a debilitating, potentially blinding illness in patients over 60 years of age. We describe the heterogeneity of clinical presentation and discuss techniques to diagnose and manage the disease in a manner which limits visual loss.

Method: Case Reports of two patients with TA diagnosed and managed at our tertiary centre, utilising multisystem management in a tertiary setting to achieve excellent clinical and visual outcomes. A literature review was undertaken.

Results: The clinical presentation of TA is highly variable, and must be excluded in the presence of polymyalgia . We have reviewed the literature regarding optimal investigations, as well novel and established treatment regimens, and discuss the evidence favouring glucocorticoids, immunomodulators, biologic agents, anticoagulants and antiplatelet agents.

Conclusion: TA is a clinical diagnosis based upon the presentation of a constellation of symptoms and signs. Given the potentially devastating outcomes, and the disease's responsiveness to therapy, a high level of clinical suspicion is warranted.