The Rational Clinical Examination
David L. Simel, Drummond Rennie
Temporal Arteritis
Gerald W. Smetana, Robert H. Shmerling
The physical examination result is frequently unremarkable in patients with TA, but the detection...
Topics Discussed:
diagnostic process, giant cell arteritis, jaw claudication
Excerpt:
"When faced with a patient with headache, fatigue, or other possible
presenting symptom of TA, clinicians must be able to correctly and
confidently establish the diagnosis to prevent irreversible vision
loss and to minimize the inappropriate evaluation and treatment
of alternative diagnoses. Although headache is the most common reason
for clinical suspicion of TA, no single type of headache or other
clinical presentation is specific for TA, and the disorder is among
the diagnostic considerations for many symptom complexes in older individuals.
Our review will analyze the diagnostic value of these varied symptoms
and signs in predicting the likelihood of TA among patients for whom
there is a clinical suspicion of disease.The clinical manifestations of TA are a direct consequence of
local (or "arteritic") and systemic inflammatory
disease. Localized arterial inflammation, particularly in the smaller
branches of the external carotid artery, cause endovascular damage,
vessel stenosis, and occlusion, ultimately leading to tissue ischemia
or necrosis. Examples of localized arteritic symptoms include jaw
claudication, caused by involvement of the masticatory muscles,
and vision loss caused by involvement of the ophthalmic or posterior
ciliary arteries. The particular cytokine profile may contribute
to the ischemic and prominent constitutional features, such as malaise,
fever, or weight loss.19,20..."
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