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Clinical Crossroads Update
December 5, 2007

Update: An 81-Year-Old Woman With Temporal Arteritis

JAMA. 2007;298(21):2536. doi:10.1001/jama.298.21.2536

In a Clinical Crossroads1 article published in June 2006, Dr Robert Shmerling, MD, discussed the diagnostic criteria and treatment options for temporal arteritis. The discussion centered on Mrs V, an active 81-year-old woman with a medical history significant for hypertension, multiple fractures, toxic multinodular goiter, lichen planus, and allergic rhinitis. Mrs V presented with a severe headache and described additional intermittent symptoms, including difficulty opening her mouth, pain behind her eye, and unusual lumps on her forehead. Her physical examination was normal and her erythrocyte sedimentation rate was 46 mm/h. A temporal artery biopsy showed active giant-cell arteritis with intimal edema and focal fibrinoid necrosis. Dr Shmerling recommended that Mrs V undergo a minimum of 4 to 6 months of corticosteroid therapy, extending to 1 to 2 years if necessary. At the conference, Mrs V wondered how long she had had temporal arteritis before it was diagnosed.