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Giant Cell Arteritis Diagnosis and Management Update

What is Giant Cell Arteritis?. Ophthalmic Emergency. .

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Giant Cell Arteritis Diagnosis and Management Update

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    1. Giant Cell Arteritis Diagnosis and Management Update Roger Baer May 2008

    2. What is Giant Cell Arteritis? Ophthalmic Emergency

    3. What is Giant Cell Arteritis?

    5. Diagnostic Criteria Age (=50y.o) New onset of localised headache Temporal artery tenderness or decreased temporal artery pulsation Elevated ESR (=50mm/h) Positive TAB

    7. Hayreh & Zimmerman Study Opthalmologica August 2003; 217:239-259 Sohan Singh Hayreh, Bridget Zimmerman

    8. Hayreh & Zimmerman Study Occult GCA 21.2% of patients with visual loss and a positive TAB had no other symptoms

    9. Hayreh & Zimmerman Study Criteria Missing from ACR Guidelines Likelihood of a positive TAB were: ? 9.0 times greater if associated with jaw claudication ? 3.4 times greater if associated with neck pain ? 3.2 times greater if associated with CRP >24.5mg/l

    10. Hayreh & Zimmerman Study Headache & Scalp Tenderness 55.7% of patients with a positive TAB complained of a ‘new onset of localised headache’

    12. Hayreh & Zimmerman Study Clinically Abnormal Temporal Artery 19.8% of patients with a positive TAB had temporal artery tenderness or decreased temporal artery pulsation

    13. Hayreh & Zimmerman Study Elevated ESR Whilst the ACR guidelines advocated an ESR of =50mm/h, this study showed a presenting ESR in patients with a positive biopsy of 4-140mm/h.

    14. Hayreh & Zimmerman Study Conclusion Reliance on the ACR Guidelines is likely to result in both false-negative and false-positive diagnoses of Giant Cell Arthritis

    15. Hayreh & Zimmerman Study

    16. Hayreh & Zimmerman Study

    17. Hayreh & Zimmerman Study

    18. Hayreh & Zimmerman Study

    19. Hayreh & Zimmerman Study

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    25. Hayreh & Zimmerman Study Age (=55y.o) Yes, check inflammatory markers Visual symptoms? No, consider other criteria: Jaw claudication CRP >24.5mg/l Neck pain ESR >47mm/h Age =75y.o Temporal Artery Biospy

    26. Hayreh & Zimmerman Study

    27. Hayreh & Zimmerman Study

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    31. Hayreh & Zimmerman Study

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