A 78 year old woman presents with unilateral headache and pain on chewing. Her ESR is 70 mm/hour. She is on oral steroids. What is the SINGLE most appropriate additional treatment?
A. Bisphosphonates
B. Hormone replacement therapy
C. ACE inhibitors
D. Beta blockers
E. Timolol
The elderly lady with giant cell arteritis is getting high dose steroid which can lead to demineralization and osteopenia or osteoporosis. So to prevent this bisphosphonates are given.
The diagnosis here is clear. She has temporal arteritis. In these situations, question writers always ask which medication could be added onto the current regimen. There are two things that one can think of.
Bisphosphonates are important and can be considered to add on to reduce the risk of osteoporosis. Especially in an elderly females.
Low dose aspirin is increasingly being recommended for people with a history of giant cell arteritis. It has been found to decrease the rate of visual loss and strokes in patients with GCA.
As low dose aspirin is not in the given options, bisphosphonates is your pick.
TA (Temporal Arteritis) TA (Temporal Arteritis), also known as giant cell arteritis, is a vasculitis affecting the large arteries that supply the head, eyes, and optic nerves. New-onset headache in any patient older than 50 years prompts consideration of this diagnosis, which if left untreated may result in permanent vision loss.
The most common symptoms of giant cell arteritis are headache and pain that usually occurs in one or both temples. Other common symptoms include: scalp tenderness (pain when combing hair, jaw claudication (jaw pain when chewing), decreased vision or blurry vision, tongue numbness, or, rarely, sudden loss of vision. Sometimes the patient may have proximal stiffness (neck, arms, and hips) due to polymyalgia rheumatica, a coexisting condition with TA.
The erythrocyte sedimentation test (ESR) is the first test to do in patients suspected to have TA.
The diagnosis is always confirmed by biopsy of the temporal arteries in which the characteristic giant cells are demonstrated. In the patient whom you suspect to have TA, if the ESR is elevated, corticosteroids should be started immediately, before the temporal artery biopsy is performed.
Occasionally they may ask which medication can be added onto corticosteroids for treatment of GCA. Add on low-dose aspirin. Aspirin 75 mg daily has been shown to decrease the rate of visual loss and strokes in patients with GCA.