Diagnóstico y tratamiento de una arteritis temporal en urgencias

Abstract

Temporal arteritis is a vasculitis of the medium and large vessels that affects the extracranial branches of the carotid artery. This condition is characterized by a combination of focal inflammation causing arterial stenosis or occlusion and systemic inflammation manifested as polymyalgia rheumatica, constitutional symptoms and changes in laboratory tests. The only feature of giant cell arteritis (GCA) that is not controversial is its classification as the first medical emergency in ophthalmology. Visual loss occurs in up to a fifth of patients.

Prompt recognition of the disease and early initiation of therapy can prevent loss of vision in the affected eye or new visual deficits in the contralateral eye. The treatment of GCA is based on daily glucocorticoid administration, which should be started urgently in patients with incipient visual symptoms (diplopia or amaurosis fugax). The duration of glucocorticoid therapy is unpredictable and adverse effects are common. The aim of treatment is mainly to prevent the progression of visual loss.