Q: I am a 76-year-old male. I was diagnosed with temporal arteritis and was put on prednisone for two years. Since then I have had inflammation in my right thigh and foot. My eye doctor said I have inflammation in both eyes. It’s been recommended I see a rheumatologist. What can I expect and what can I do?
A: Temporal arteritis is inflammation that leads to damage of the blood vessels that supply blood to the head. The condition commonly occurs in the temporal arteries that branch off from the carotid artery which is located in the neck. However, arteritis can also occur in other arteries in other areas of the body. While the cause for it remains unknown, it is believed to be due, at least in part, to an immune response that is faulty, or possibly to severe infections, or because of the use of high doses of antibiotics.
Symptoms may include tenderness of the scalp on palpation, severe headaches on one side of the head or at the back of the head, pain and stiffness of the neck/shoulder/upper arms, fever, jaw pain that exacerbates and dissipates when chewing, and more. There may be issues with the eyes as well, that include blurred or double vision and blindness or reduced vision in one or both eyes. There may be facial pain, hearing loss, and joint stiffness.
While blood tests alone may not provide all the answers a physician requires, a C reactive protein, sedimentation rate, hematocrit and liver function tests may be ordered. The physician in charge may also choose to order imaging studies that include an MRI or ultrasound; however, the diagnosis of choice is a temporal artery biopsy.
Treatment, as you have already begun, will commonly include corticosteroids that may appear to cause improvement within a few days but which may have to be taken for an extended period of time – between one to two years. This long-term use of steroids can increase a person’s risk of fracturing a bone or bones. Corticosteroids, even in low doses, may cause additional side effects that include weight gain, osteoporosis, cataracts, insomnia, bruising, and more. Therefore, because the osteoporosis may have been caused by prednisone, you should speak with your physician about taking a calcium supplement with vitamin D, avoiding smoking altogether if appropriate, reducing your alcohol intake if appropriate, having periodic bone density scans, and seeing the rheumatologist to which he refers. A rheumatologist is a specialist in joint diseases.
Temporal arteritis/giant cell arteritis (inflammation of the lining of the arteries) may develop with or may follow with polymyalgia rheumatica (PMR), another inflammatory disorder. PMR presents with widespread aches and stiffness in adults over the age of 50. Women appear to be at a slightly greater risk for developing PMR than are men, Caucasians more so than non-Caucasians. Symptoms may appear in the upper arms, neck, buttocks and thighs and be more severe in the morning. Symptoms tend to appear rather quickly with both sides of the body equally affected.
PMR can be diagnosed through lab testing that includes a sedimentation rate and a C-reactive protein (CRP). The condition may be difficult to diagnose, because both lab tests may be extremely elevated in most patients, yet normal to minimally elevated in others.
