Rheumatology Question 32 Instructor

List 6 features that should raise suspicion of giant cell arteritis (GCA or temporal arteritis) in a patient over age 50. What features on history and exam carry the highest likelihood ratio for the presence of giant cell arteritis?

The risk of giant cell arteritis rises with increasing age and the condition does not occur in patients under age 50. Features that should raise suspicion of GCA in this population include:

  1. New headache
  2. Temporal artery abnormality (tenderness or decreased pulsation)
  3. Scalp tenderness
  4. Jaw claudication
  5. Tongue claudication
  6. Arm claudication
  7. Sudden visual disturbances
  8. ESR ≥50mm/h by Westergren method

Features that confer a high likelihood of temporal arteritis include the following:

  1. Jaw Claudication (LR +4.2)
  2. Diplopia (LR +3.1)
  3. Beaded Temporal Artery (LR +4.6)
  4. Prominent or enlarged artery (LR +4.3)
  5. Tender temporal artery (LR +2.6)
  6. Absent temporal artery pulse (LR +2.7)

Smetana GW, Shmerling RH. Does this patient have Temporal Arteritis? JAMA 2002 January 2;287:92-101

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