Topic: Temporal Arteritis Subject: Medicine A 70-year-old woman returns to the office because of aching and weakness in her arms to the point where she cannot lift her arm to brush her hair. Physical examination shows no muscle tenderness or other evidence of joint disease in both arms. The aching improves when she takes the prescribed nonsteroidal anti-inflammatory drug (NSAID). She also describes tenderness over the right temporal area of her scalp. Physical examination of the scalp shows no lesions. Which of the following is the most appropriate next step?
A. Increase the dose of the NSAID
B. Order determination of erythrocyte sedimentation rate
C. Order determination of serum rheumatoid factor
D. Order x-ray films of the cervical spine
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Correct Answer : B.
The tenderness over the right temporal area of the patients scalp is worrisome for temporal arteritis, which is often associated with an elevated erythrocyte sedimentation rate. Prompt treatment with steroids is often indicated to prevent blindness. The diagnosis can be established with a temporal artery biopsy. Increasing her dose of NSAIDs is incorrect. The most common treatments for pain are the nonsteroidal anti-inflammatory drugs, or NSAIDs. If this is ineffective, oral steroids such as prednisone should be started. Since this patient does not have signs or symptoms consistent with any type of arthritis (no joint disease; arthritis is a disease of joints), a serum RF is not useful. A radiograph of the cervical spine is not indicated here as this patient does not describe radicular symptoms that could be attributed to compression of single nerve root. Rather, her symptoms are of generalized weakness. This is not a symptom that a cervical disc could be responsible for.