Temporal Arteritis Evaluation

Description

Shmerling proposed an algorithm for the diagnosis and management of a patient with possible temporal arteritis. The author is from Beth Israel Deaconess Medical Center in Boston.

Patient selection: presence of clinical findings suggestive of temporal arteritis

Parameters:

(1) clinical suspicion based on history, physical examination and laboratory testing

(2) vision

(3) findings on temporal artery biopsy

Suspicion	Vision	Initial Management
none	NA	evaluate for an alternative diagnosis
low	NA	perform temporal artery biopsy
moderate or high	unaffected	start oral corticosteroid therapy; perform temporal artery biopsy
moderate or high	affected	start intravenous corticosteroid therapy; perform temporal artery biopsy

where:

• If the suspicion is low and vision is affected, then the suspicion is bumped up to moderate in the implementation.

Oral corticosteroid therapy: prednisone 1 mg/kg per day or equivalent

IV corticosteroid therapy: methylprednisolone 80 mg per 8 hours

Suspicion	Initial Biopsy	Additional Management
low	negative for TA	evaluate for an alternative diagnosis
low	positive for TA	start oral corticosteroid therapy (as above)
moderate	negative for TA	consider biopsy of contralateral temporal artery
moderate	positive for TA	continue therapy as listed above
high	negative for TA	perform a biopsy of contralateral temporal artery
high	positive for TA	continue therapy as listed above

Suspicion	Contralateral Biopsy	Additional Management
moderate	negative or not done	discontinue steroid therapy; consider alternative diagnosis
moderate	positive	continue therapy as listed above
high	negative	consider continued corticosteroid therapy while looking for an alternative diagnosis
high	positive	continue therapy as listed above

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Description

Specialty

Objective

ICD-10

Purpose: To evaluate a patient with possible temporal arteritis using the algorithm of Shmerling.

Description

Specialty

Objective

ICD-10