• It is a granulomatous vasculitis involving large vessels.
• It is usually seen over 50 years old and in women.
• It often involves the carotid artery and its branches (most commonly the temporal artery).
• DHA; It occurs with head/scalp pain, jaw claudication, fever, increased erythrocyte sedimentation rate.
• The most feared complication is ophthalmic artery involvement (may result in irreversible vision loss).
• Cerebrovascular events (vertigo, transient ischemic attack, stroke, etc.) and signs of large vessel involvement (claudication in the extremities, blood pressure-pulse difference, etc.) can be seen.
• Polymyalgia may accompany rheumatica.
Diagnosis
• Clinical findings and temporal artery biopsy are combined in diagnosis.
• In case of suspected DHA accompanied by visual impairment, biopsy is not expected for diagnosis.
Steroids should be given immediately (biopsy can be taken up to 14 days after starting steroids).
• Detection of hypoechoic halo around the artery in Doppler USG is 100% specific.
Treatment
• The main treatment is steroids.
• Tocilizumab (anti IL6 receptor antibody) is more effective than steroid therapy.
• In the presence of vision-threatening involvement, pulse steroid should be given.
Polymialgia Romatic
• It is the most common disease accompanying DHA.
• It is usually seen over 50 years old and in women.
• It is characterized by proximal muscle pain.
• No loss of muscle strength.
• Sedimentation rate and CRP are significantly higher.
• Muscle enzymes, EMG and muscle biopsy are normal.
• It responds dramatically to low-dose steroids (10-20 mg/day).