Extract from PMR-GCA Support East Anglia, Newsletter No.9 Apr 2010
Dr. Watts talk
The Significance between Polymyalgia Rheumatica and Giant Cell Arteritis.
At our October meeting, Dr Watts Consultant Rheumatologist at IpswichHospital, spoke of clinical studies which show the close relationship between PMR and GCA, with 25% of patients with PMR suffering GCA, and 25% of those with GCA suffering PMR. He went on to give a resume of PMR symptoms and treatment, before focusing on GCA. He explained that the sudden onset of new or different headaches in the temporal area (the temples), disturbance to vision or visual loss, painful jaw on eating, and PMR symptoms indicates the onset of Giant Cell Arteritis. He explained that this condition rarely affects those under the age of 60, and like PMR, is more common in women than men.
To diagnose GCA a physical examination would show temporal tenderness, no pulses and visual disturbance. Blood tests (ESR & CRP*) would show the inflammation level, although these tests do not conclusively diagnose either PMR or GCA. Checks on other organs of the body along with the blood tests help to rule out other medical conditions. Dr Watts said; “Doctors may request a biopsy of the temporal artery which would help in an early diagnosis. In the future it is hoped an Ultra Sound Scan of the temporal artery could be carried out to avoid a biopsy”.
Dr Watts went on to detail the treatment: To bring down the inflammation and prevent serious visual loss or even blindness, an immediate high dose of steroids must be prescribed with a gradual reduction of dose, and regular ESR & CRP blood tests to monitor disease activity. Patients should also be given preventative medication against osteoporosis.
The Questions & Answers
Q. 15mg of Prednisolone caused a stomach bleed. Is there an alternative i.e. methotextrate and should medication be given to protect the stomach?
A. There are alternatives but they are not as good. It would be preferred to get off
steroids or lower the dose and take other drugs to help.
Q. I suffer from PMR and I take 800mg Calcium/Vitamin D a day. Is this enough
to protect against Osteoporosis. I do not have Osteoporosis.
A. These can be taken only as an addition to Alendronic Acid/Risedronate sodium
(bisphosphonates) the once a week/once a month tablet to protect against Osteoporosis.
Q. Who would carry-out a biopsy?
A. An Ophthalmologist at the hospital might but usually a general surgeon, not an Optician.
*ESR: erythmo sedimentation rate. CRP c-reactive protein test.
Q. You stated no muscle weakness, but I experience muscle weakness.
A. Weakness of muscles is not usually due to PMR alone. We would look for otherreasons.
Q. Can the arteries in the legs be blocked?
A. Yes, and could be due to smoking and conditions such as heart disease, and the
furring-up of arteries due to fat in blood or diabetes.
Q. Contact with Chicken Pox and Shingles. As steroids reduce the ability to fight infection,
particularly when on a low dose, is it advisable to increase the dose if an infection is
picked up? Also, is a Synachten Test advisable?
A. 1) A low dose of prednisolone does not affect the ability to fight infection.
2) A GP may recommend an increased dose for a short period only if a
major infection is contracted.
3) A Synachten Test would not be recommended as it is only done to determine if
the body is relying on Prednisolone and therefore not helpful.
4) The usual Flu Vaccination is essential especially as sufferers of PMR/GCA
are usually over 60years of age.
Q. Can PMR be confused with Cervical Spondylosis, also does Raynaud’s Disease have any
connection to PMR?
- Cervical Spondylosis is not directly related to PMR/GCA and there is no connection
to Raynaud’s Disease. Dr. Watts stressed that it again comes back to careful monitoring,
as steroids reduce symptoms.
Q. I have GCA and have symptoms of shooting pain across the temple will this get worse as
the steroid dose is reduced?
A This will depend on the dosage and by how much it is reduced. It is always a question
of weighing up the risks of reduction or indeed the increase of steroids and why it is
necessary for blood tests be taken to determine dosage.
Q. Is PMR/GCA hereditary or does it run in families?
A. The condition is usually triggered by infection. There is no convincing evidence
to suggest it is hereditary. Further work on genetic risk factors is needed.
Q. I have had GCA and PMR since 1998. I have been on Methotrexate for nearly 2years.
Recently the dose was increased from 10mg to 15mg. My Prednisolone dose was reducing
from 9mg to 8mg when a relapse occurred. Is this usual? ESR and CRP tests were normal
- This is a typical example of reduction of drugs.
Because of the relationship between the two illnesses and the significant overlap, this excellent talk and question time was most valuable not only for those in the audience with GCA, but also to extend the knowledge of those with PMR and their companions concerning the implications of Giant Cell Arteritis.
Dr. Watts was thanked warmly for such helpful advice.