Heeding clues to giant cell arteritis

PREVIEW

A 74-year-old woman presents to your office on a Friday at 2: 00 PM with a chief complaint-of a right-sided, throbbing headache. It has been present for 3 to 4 weeks, concomitant with fatigue and mild muscle aches. The patient has no history of trauma or visual symptoms. No temporal artery tenderness or funduscopic abnormality is found on physical examination. Her hemoglobin is 11 g/dL, hematocrit is 33%, and erythrocyte sedimentation rate (ESR) is 104 mm/hr. How would you proceed? Drs Lichtstein and Caceres use this case example to illustrate their approach to diagnosis of giant cell arteritis.