DEAR DR. GOTT: In early December I had pain an inch wide at the back of my head. After having a biopsy, my diagnosis was temporal arteritis – inflammation of the artery. My doctor says there is no cure. I started taking high doses of prednisone and the pain has started to go away but will the arteritis ever go away?
I’ve gained 15 pounds, even though my eating habits are the same as before. I always weighed 125 but am up to 140. Can I do anything about the weight problem? I’m 83 and never had a headache before. Is there an operation or anything to fix the arteritis? I’ll be watching the Journal Inquirer for your response.
DEAR READER: I am grateful and fortunate to receive many questions and comments through the Journal Inquirer in Manchester, CT and will do what I can to provide you with information, as well.
Giant cell arteritis (also known as temporal or cranial arteritis) is inflammation of the lining of the blood vessels that carry oxygen-rich blood from the heart throughout the body. The condition most frequently affects the arteries of the head and temples, causing jaw pain, headache, blurred or double vision, and more. While the specific cause of arteritis remains unknown and there isn’t a known cure at this stage, being over the age of 70, female and those carrying a diagnosis of polymyalgia rheumatica increases a person’s risk for the condition. Symptoms may begin with head tenderness and muscle pain throughout the body. Pain may be present in one or both temple areas. Jaw pain, fever, tenderness of the scalp and decreased vision may also be present. If left untreated, complications can include aneurysm, stroke and the permanent loss of vision in one or both eyes.
Diagnosis can be difficult in the early stages because the symptoms experienced resemble those of many other medical conditions. A physical examination and laboratory testing to include a sedimentation rate and C-reactive protein (CRP) will be of great assistance; however, the best method for diagnosis is through biopsy of the temporal artery; yet even that specific testing can provide false results. When questions remain, other possible testing may include an MRI, ultrasound, or PET scan.
Prednisone is in a class of drugs known as corticosteroids. It prevents the release of substances in the body that cause inflammation. Your physician was correct in ordering it as it likely saved your vision, even though the medication is known to cause weight gain, indigestion, nervousness, insomnia, a diminished immune system, elevated blood sugar levels, and easy bruising. To complicate the issue, long-term use of prednisone can lead to hypertension, cataracts, glaucoma, and more. Because of this and as an offset, your physician may choose to pay close attention to your bone density testing and blood pressure readings. He or she may also prescribe calcium with vitamin D supplements and an 81 mg aspirin daily. You may be on prednisone for a year or two, perhaps even longer, under strict medical guidance to prevent a relapse. This will depend on how severe your condition is. Some individuals may even be prescribed a drug known as methotrexate commonly used to treat specific cancers and rheumatoid arthritis for symptom control. Research on this drug has been ongoing and looks promising.
Because of the side effects of prednisone, you should focus your attention on eating a diet rich in fresh fruits, vegetables, whole grains, fish and lean cuts of meat. Take between 1,000 and 1,500 mg of calcium and 800 IU of vitamin D daily. Pass up the sugar, salt and alcohol. Keep in mind that your weight increase will level off once you reduce or discontinue the dosage of the prednisone. You’re on the right track so stick with it.
Readers who would like related information can order my Health Report “Consumer Tips on Medicine” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order directed to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
