|A.||Aspirin 150 mg orally daily|
Measurement of erythrocyte sedimentation rate
Immediate initiating of glucocorticoid
Referral for temporal artery biopsy
The patient has a classic presentation for giant-cell arteritis with associated polymyalgia rheumatica including headache, jaw claudication, and visual disturbances. Her age makes this diagnosis highly likely as well.
The diagnosis is confirmed by temporal artery biopsy; however, in the presence of visual symptoms, initiation of therapy should not be delayed pending a biopsy because the biopsy may be positive even after approximately 14 days of glucocorticoid therapy.
Delay in therapy risks irreversible visual loss.
Additionally, a dramatic response to therapy may lend further support to the diagnosis.
The primary therapy is prednisone at 40–60 mg daily for 1 month with gradual tapering.
Although ESR is nearly universally elevated, it is not specific for the diagnosis.
Temporal artery ultrasound may be suggestive but is not diagnostic.