a systemic granulomatious large vessel arteritis, mainly affecting cranial arteries, and occurring mostly in the elderly age group, and frequently associated with polymyalgia rheumatica. Presenting with usually unilateral headache, visual disturbances like amaurosis, scotoma, diplopia, optic neuritis and blindness, tender swollen temporal artery, scalp tenderness, polymalgia rheumatica in 50%. ITA and stroke in a small number, ESR raised over 50mms an hour, and diagnosis by temporal artery biopsy may still be done within 3 days of starting therapy. Resolves well with therapy, but lasts for 3-4 years, and high risk of blindness in the untreated
Treatment
Start with 60mg prednisone, in divided doses initially, and then single morning dose, and continue for 4 weeks. Slow taper (if symptoms subside, and ESR falls), over a period of 4 weeks, and then maintain for some months to a year on 10-15 mg daily. Try tapering every 3 months, monitoring symptoms and ESR. Therapy may be needed for several months to years
