A 70-year-old woman is seen by her physician for evaluation of severe headaches. She noted these several weeks ago, and they have been getting worse. Although she has not had any visual aura but she has been intermittently losing vision in her left eye for the last few days. She denies new weakness or numbness, but she does repo jaw pain with eating. Her past medical history includes coronary aery disease requiring a bypass grafting 10 years prior, diabetes mellitus, hyperlipidaemia, and mild depression. Full review of symptoms is notable for night sweats and mild low back pain paicularly prominent in the morning. Which of the following is the next most appropriate step?
The patient has a classic presentation for giant-cell aeritis with associated polymyalgia rheumatica. Clinical feature: Headache, jaw claudication, and visual disturbances. Diagnosis Confirmed by temporal aery biopsy. ESR elevated (100mm) Treatment: In the presence of visual symptoms, initiation of therapy should not be delayed. The DOC is prednisone at 40-60 mg daily for 1 month with gradual tapering.
Aspirin 975 mg orally daily
Measurement of erythrocyte sedimentation rate
Immediate initiation of glucocoicoid
Referral for temporal aery biopsy
Vasculitis