Temporal Arteritis in Emergency Medicine Treatment & Management

  • Author: Christopher H Lee, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 15, 2011
 

Prehospital Care

Patients generally do not present via emergency medical services, and no particular prehospital interventions are warranted.

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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.

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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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Contributor Information and Disclosures
Author

Christopher H Lee, MD  Clinical Instructor, Section of EMS, Department of Emergency Medicine, Yale University School of Medicine

Christopher H Lee, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Jean Marie Hammel, MD  Assistant Professor, Associate Residency Director of Emergency Medicine Residency Program, Department of Surgery, Section of Emergency Medicine, Yale University School of Medicine

Jean Marie Hammel, MD is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard S Krause, MD  Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Gino A Farina, MD, FACEP, FAAEM  Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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Hematoxylin and eosin stained superficial temporal artery biopsy specimen, cross section. The hallmark histologic features of giant cell arteritis shown here include intimal thickening with luminal stenosis, mononuclear inflammatory cell infiltrate with media invasion and necrosis, and giant cell formation in the media.
Lumbar angiogram showing stenosis and occlusion of femoral artery branches due to vasculitis in the same patient whose temporal artery biopsy specimen is shown in the previous image.
Hematoxylin and eosin stained femoral artery branch, cross section, taken from a lower limb amputation specimen. Mononuclear cell invasion and necrosis in the media of this large artery can be observed. Extensive lower limb vasculitis from giant cell arteritis resulted in ischemic necrosis of the lower limb, necessitating amputation.
 
 
 
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