Temporal Arteritis in Emergency Medicine Treatment & Management
- Author: Christopher H Lee, MD; Chief Editor: Rick Kulkarni, MD more...
Prehospital Care
Patients generally do not present via emergency medical services, and no particular prehospital interventions are warranted.
Emergency Department Care
Optimal care of patients with temporal arteritis in the emergency department involves maintaining a high index of suspicion and a low threshold to treat.
Treatment consists of corticosteroids. Although corticosteroids are the only proven treatment of temporal arteritis, few studies exist regarding dosing protocols. It is generally agreed that patients with suspected temporal arteritis should be started on oral prednisone 60 mg/day in the emergency department, with a temporal artery biopsy performed as an outpatient procedure scheduled within 1 week.
Improvement of systemic symptoms typically occurs within 72 hours of initiation of therapy. Patients should be counseled that corticosteroid therapy may be lengthy (1-2 y) and can lead to the typical complications associated with long-term steroid use. Recent data suggest that initial high-dose intravenous corticosteroid administration is beneficial in reducing temporal arteritis remission rates.[5] However, further study is warranted before this is routinely practiced.
Consultations
An ophthalmologist should be consulted for a complete, dilated ocular examination to rule out other causes of vision loss, particularly when the diagnosis is uncertain.
A rheumatologist or internist should direct follow-up care for these patients, monitor remissions and recurrence, and manage complications associated with long-term corticosteroid therapy.
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