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Treatment of Vision Loss in Giant Cell Arteritis
Opinion statement If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte...
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Published in: | Current treatment options in neurology 2012-02, Vol.14 (1), p.84-92 |
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container_title | Current treatment options in neurology |
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creator | Scheurer, Ryan A. Harrison, Andrew R. Lee, Michael S. |
description | Opinion statement
If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC). Treatment begins with high-dose intravenous corticosteroids. We recommend intravenous methylprednisolone (250 mg every 6 h) for 3 to 5 days. During that time, a temporal artery biopsy should be performed for pathologic diagnosis. We also begin daily adjunctive aspirin orally. After the initial bolus of intravenous corticosteroids, therapy transitions to oral prednisone administered at 1 mg/kg per day until the activity of the disease process attenuates, as demonstrated by improvement in systemic symptoms and normalization of both ESR and CRP. This change usually occurs in the first 3 to 4 weeks. The patient should be followed closely, with therapy tapered as guided by systemic symptoms, ESR, and CRP. To maximize the use of remaining vision, appropriate patients should be referred to specialists for help with low-vision therapies, assistive devices, and precautions to protect the better-seeing eye. |
doi_str_mv | 10.1007/s11940-011-0152-7 |
format | article |
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If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC). Treatment begins with high-dose intravenous corticosteroids. We recommend intravenous methylprednisolone (250 mg every 6 h) for 3 to 5 days. During that time, a temporal artery biopsy should be performed for pathologic diagnosis. We also begin daily adjunctive aspirin orally. After the initial bolus of intravenous corticosteroids, therapy transitions to oral prednisone administered at 1 mg/kg per day until the activity of the disease process attenuates, as demonstrated by improvement in systemic symptoms and normalization of both ESR and CRP. This change usually occurs in the first 3 to 4 weeks. The patient should be followed closely, with therapy tapered as guided by systemic symptoms, ESR, and CRP. To maximize the use of remaining vision, appropriate patients should be referred to specialists for help with low-vision therapies, assistive devices, and precautions to protect the better-seeing eye.</description><identifier>ISSN: 1092-8480</identifier><identifier>EISSN: 1534-3138</identifier><identifier>DOI: 10.1007/s11940-011-0152-7</identifier><identifier>PMID: 22037998</identifier><language>eng</language><publisher>New York: Current Science Inc</publisher><subject>Critical Care Medicine ; Diabetes ; Family Medicine ; General Practice ; Intensive ; Internal Medicine ; Medicine ; Medicine & Public Health ; Neurologic Ophthalmology and Otology (RK Shin ; Neurology ; Ophthalmology ; Section Editor</subject><ispartof>Current treatment options in neurology, 2012-02, Vol.14 (1), p.84-92</ispartof><rights>Springer Science+Business Media, LLC 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-2fab237b05804ca88e62a53c7d706caa1d5101ff70fbcb8cbfd7112e14bf33883</citedby><cites>FETCH-LOGICAL-c435t-2fab237b05804ca88e62a53c7d706caa1d5101ff70fbcb8cbfd7112e14bf33883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22037998$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Scheurer, Ryan A.</creatorcontrib><creatorcontrib>Harrison, Andrew R.</creatorcontrib><creatorcontrib>Lee, Michael S.</creatorcontrib><title>Treatment of Vision Loss in Giant Cell Arteritis</title><title>Current treatment options in neurology</title><addtitle>Curr Treat Options Neurol</addtitle><addtitle>Curr Treat Options Neurol</addtitle><description>Opinion statement
If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC). Treatment begins with high-dose intravenous corticosteroids. We recommend intravenous methylprednisolone (250 mg every 6 h) for 3 to 5 days. During that time, a temporal artery biopsy should be performed for pathologic diagnosis. We also begin daily adjunctive aspirin orally. After the initial bolus of intravenous corticosteroids, therapy transitions to oral prednisone administered at 1 mg/kg per day until the activity of the disease process attenuates, as demonstrated by improvement in systemic symptoms and normalization of both ESR and CRP. This change usually occurs in the first 3 to 4 weeks. The patient should be followed closely, with therapy tapered as guided by systemic symptoms, ESR, and CRP. To maximize the use of remaining vision, appropriate patients should be referred to specialists for help with low-vision therapies, assistive devices, and precautions to protect the better-seeing eye.</description><subject>Critical Care Medicine</subject><subject>Diabetes</subject><subject>Family Medicine</subject><subject>General Practice</subject><subject>Intensive</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurologic Ophthalmology and Otology (RK Shin</subject><subject>Neurology</subject><subject>Ophthalmology</subject><subject>Section Editor</subject><issn>1092-8480</issn><issn>1534-3138</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNp9kMFOwzAMhiMEYmPwAFxQb5wKdtIs6XGaYCBV4jK4RmmaoExrO5L2wNuTqYMjB8uW_fuX_RFyi_CAAOIxIpYF5ICYgtNcnJE5clbkDJk8TzWUNJeFhBm5inEHQHmBeElmlAITZSnnBLbB6qG13ZD1Lvvw0fddVvUxZr7LNl6n_tru99kqDDb4wcdrcuH0PtqbU16Q9-en7folr942r-tVlZuC8SGnTteUiRq4hMJoKe2Sas6MaAQsjdbYcAR0ToCrTS1N7RqBSC0WtWNMSrYg95PvIfRfo42Dan006RTd2X6MqsQlp-mHMilxUpqQ7g7WqUPwrQ7fCkEdOamJk0qc1JGTEmnn7uQ-1q1t_jZ-wSQBnQQxjbpPG9SuH0OXPv7H9QfVLXF9</recordid><startdate>20120201</startdate><enddate>20120201</enddate><creator>Scheurer, Ryan A.</creator><creator>Harrison, Andrew R.</creator><creator>Lee, Michael S.</creator><general>Current Science Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120201</creationdate><title>Treatment of Vision Loss in Giant Cell Arteritis</title><author>Scheurer, Ryan A. ; Harrison, Andrew R. ; Lee, Michael S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-2fab237b05804ca88e62a53c7d706caa1d5101ff70fbcb8cbfd7112e14bf33883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Critical Care Medicine</topic><topic>Diabetes</topic><topic>Family Medicine</topic><topic>General Practice</topic><topic>Intensive</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurologic Ophthalmology and Otology (RK Shin</topic><topic>Neurology</topic><topic>Ophthalmology</topic><topic>Section Editor</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Scheurer, Ryan A.</creatorcontrib><creatorcontrib>Harrison, Andrew R.</creatorcontrib><creatorcontrib>Lee, Michael S.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Current treatment options in neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Scheurer, Ryan A.</au><au>Harrison, Andrew R.</au><au>Lee, Michael S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of Vision Loss in Giant Cell Arteritis</atitle><jtitle>Current treatment options in neurology</jtitle><stitle>Curr Treat Options Neurol</stitle><addtitle>Curr Treat Options Neurol</addtitle><date>2012-02-01</date><risdate>2012</risdate><volume>14</volume><issue>1</issue><spage>84</spage><epage>92</epage><pages>84-92</pages><issn>1092-8480</issn><eissn>1534-3138</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Opinion statement
If giant cell arteritis is suspected as a cause of visual loss, emergent management is necessary. Clinical suspicion should prompt the practitioner to obtain laboratory studies and initiate treatment prior to establishing the diagnosis. The evaluation includes immediate erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complete blood count (CBC). Treatment begins with high-dose intravenous corticosteroids. We recommend intravenous methylprednisolone (250 mg every 6 h) for 3 to 5 days. During that time, a temporal artery biopsy should be performed for pathologic diagnosis. We also begin daily adjunctive aspirin orally. After the initial bolus of intravenous corticosteroids, therapy transitions to oral prednisone administered at 1 mg/kg per day until the activity of the disease process attenuates, as demonstrated by improvement in systemic symptoms and normalization of both ESR and CRP. This change usually occurs in the first 3 to 4 weeks. The patient should be followed closely, with therapy tapered as guided by systemic symptoms, ESR, and CRP. To maximize the use of remaining vision, appropriate patients should be referred to specialists for help with low-vision therapies, assistive devices, and precautions to protect the better-seeing eye.</abstract><cop>New York</cop><pub>Current Science Inc</pub><pmid>22037998</pmid><doi>10.1007/s11940-011-0152-7</doi><tpages>9</tpages></addata></record> |
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subjects | Critical Care Medicine Diabetes Family Medicine General Practice Intensive Internal Medicine Medicine Medicine & Public Health Neurologic Ophthalmology and Otology (RK Shin Neurology Ophthalmology Section Editor |
title | Treatment of Vision Loss in Giant Cell Arteritis |
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