From the Research
This patient's presentation suggests temporal arteritis (giant cell arteritis) with symptoms of neck spasms, dysphagia, jaw pain, and temporal tenderness, and the most appropriate course of action is to initiate high-dose corticosteroid therapy promptly, even before biopsy confirmation, to prevent vision loss, as supported by the most recent study 1. The workup should include immediate laboratory tests including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complete blood count (CBC), and comprehensive metabolic panel.
- Key symptoms to consider in the diagnosis of temporal arteritis include jaw claudication, hard end-feel limitation of range of motion, and temporal headache, as discussed in 2.
- A temporal artery biopsy should be scheduled within 1-2 weeks of starting steroids for definitive diagnosis, as the diagnosis of temporal arteritis is clinical and is not discarded by a negative biopsy, as highlighted in 3.
- Imaging studies such as temporal artery ultrasound or MRI may be helpful adjuncts, but the diagnosis is primarily based on history and physical examination.
- The patient will need close monitoring for steroid side effects and should be referred to rheumatology for long-term management, with consideration of steroid-sparing agents like methotrexate or tocilizumab later on.
- Calcium and vitamin D supplementation (1000-1200mg calcium and 800-1000 IU vitamin D daily) should be started concurrently with steroids to prevent osteoporosis, as prompt treatment is crucial to prevent permanent blindness due to inflammation of the ophthalmic artery. Some studies suggest that temporomandibular disorders may be present, but the primary concern in this case is the potential for temporal arteritis, and the treatment plan should prioritize this condition, as discussed in 4, 5.