PROGNOSIS
Disability is common in TA. In a National Institutes of Health cohort study, 74% of TA patients reported experiencing functional effects from their disease, and 47% were fully disabled.2,8 In their retrospective review of 107 cases of TA, Lupi-Herrera and colleagues reported a 14% mortality rate.31 Half the deaths in this study were attributed to congestive heart failure (CHF). A cohort study in India that included 88 patients with TA reported cumulative 5- and 10-year survival rates of 91% and 84%, respectively. Of the 10 deaths in this cohort, four were due to CHF.2,32
CONCLUSION
Signs and symptoms of rheumatologic diseases such as TA are often vague, and diagnosis may prove difficult and elusive. Repeat office visits at short intervals may prove to be helpful in making the diagnosis. Referral for radiology and/or rheumatology consultation (face-to-face, if possible) is often necessary.
In cases such as this, completing a personal review of documents and test results done elsewhere, particularly ED/inpatient hospital data, is necessary; relying on the patient’s word that “they told me everything was fine” is insufficient. Clinicians should implement a system that works best for obtaining test results and other documents, follow their instincts, and if the correct diagnosis is not arrived at immediately, keep looking.
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