- Is large vessel vasculitis which overlaps with polymyalgia rheumatica (PMR) typically in a patient > 60 years old, usually rapid onset with evidence of headache and jaw claudication in many, and visual disturbances secondary to anterior ischemic optic neuropathy in the presence of a tender, palpable superficial temporal artery.
- In contrast, PMR usually presents with myalgia, morning stiffness in proximal limb muscles (not weakness), lethargy, depression, low-grade fever, anorexia, night sweats with a raised ESR but normal CK.
- Investigations for temporal arteritis include raised inflammatory markers: ESR > 50 mm/hr and CRP may also be elevated, normal CK.
- Treatment with high dose prednisolone is started on clinical suspicion (due to the risk to vision) while awaiting temporal artery biopsy, and also because histology shows changes which characteristically “skips” certain sections of affected artery whilst damaging others hence a negative temporal artery biopsy does not rule out temporal arteritis. Patients with visual symptoms should be seen the same-day by an ophthalmologist as visual damage is often irreversible. If there is no response to prednisolone the diagnosis should be reconsidered.
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