Q&A Medicine>>>>>Rheumatology
Question 10#

A 67-year-old woman presents with severe headaches, joint pain, painful chewing, and fever. On physical examination, prominent vasculature is noted in the temporal region of the scalp. Decreased pulses are noted throughout the body. Laboratory testing reveals an ESR of 94 mm/h.

Which of the following is associated with this condition?

a. Aortic aneurysm
b. Inflammatory bowel disease
c. Hepatitis B
d. Smoking history

Correct Answer is A

Comment:

Aortic aneurysm. The patient in this question is presenting with signs, symptoms, and laboratory values consistent with a diagnosis of giant-cell arteritis (GCA), also known as temporal arteritis. Symptoms can include headache, visual problems, jaw claudication, fever, and temporal scalp tenderness. GCA is a vasculitis most commonly involving large and medium arteries of the head, predominantly the branches of the external carotid artery. A decreased temporal artery pulse can be noted as well. ESR and C-reactive protein are commonly elevated. High-dose corticosteroids should be started as soon as the diagnosis is suspected (even before confirmation by biopsy) to prevent irreversible blindness secondary to ophthalmic artery occlusion. GCA can involve branches of the aorta leading to aortic aneurysm, thus patients should have serial chest x-rays performed.

(B) Inflammatory bowel disease includes ulcerative colitis and Crohn disease and is not associated with GCA. (C) Hepatitis B is associated with polyarteritis nodosa (30% of the time), a vasculitis of medium- and small-sized arteries. (D) A smoking history is seen in thromboangiitis obliterans (Buerger disease), which presents with progressive inflammation and thrombosis of small and medium arteries of the hands and feet. Ulceration and gangrene are common complications.