Giant Cell Arteritis | Arthritis Information

 

Hello all,

Hi wildflower, the answer to your question is.........NOBODY KNOWS! lol. I started down the prednisone road because I was  scared of developing GCA and I had seen one or two brief references that suggested that taking prednisone would prevent (or help prevent) the development of GCA. However, in the following months, while on prednisone, and hating it, I spent hours and hours researching PMR and GCA and read hundreds of pages of links to the subject and found very very little about this question. Almost every article about PMR omits or avoids this question. They all say that the treatment for PMR is low dose pred, starting higher, then reducing down, but none of them say that this will help prevent GCA. However, I have found several articles that do actually say that the low doses of steroid used to treat PMR are highly unlikely to, or actually would not prevent the development of GCA.

I have seen two rheumatologists and both couldn't answer this question "yes" or "no", but both eventually said that low dose pred does probably not prevent GCA. I chose to stop my prednisone last December, and although I am struggling a bit with my PMR, I am glad I stopped the pred. Hopefully I will never get GCA, and if I do, I will then take the prednisone. Bear in mind of course that almost all people diagnosed with PMR take prednisone, and some of them will get GCA regardless, as a percentage of people with PMR will get GCA anyhow, steroids or not. I don't think there is any study material available on untreated PMR and its progression or not to GCA. Which makes me and other non-predders a guinea pig, lol! I do have some links to the articles I mentioned, but I will need to dig them out, as I have "put away my PMR" in recent weeks!

Chico, you have been so helpful to me! I have asked my doctor and I got the same response as you did from yours.  SO, the jury is still out on the connection between pred. for PMR and potentially developing GCA.  Everything I have read concurs with what you have researched.  Thanks so much!Sorry to be so long continuing on with this! I had a tidy up of the mountains of stuff I've printed out about PMR and found the main article of those I mentioned. You can read the whole thing if you go to emedicine.com then to rheumatology and then to vasculitis. The author is Ehab R Saad and his credentials look pretty good to me! Plus there is an impressive list of co-authors and editors. So to quote just a few lines that refer specifically to the question of "does prednisone prevent PMR developing into GCA?" By the way, anything in capitals are my caps!

Under a discussion about tests and lab studies, temporal artery biopsy is discussed (still talking PMR not GCA), and they say "Patients should be monitored for symptoms or signs of arteritis after treatment initiation (for PMR), because low dose corticosteroids DO NOT PREVENT progression of polymyalgia to giant cell arteritis. If clinical signs of vasculitis develop, temporal artery biopsy should be performed." It goes on to say that if a biopsy IS taken, it's result will not be affected by the low dose steroids being taken for PMR.

Under the subject of treatment for PMR: "Corticosteroids are considered the treatment of choice because they often cause complete or near-complete resolution and reduction of the ESR to normal. HOWEVER NO DEFINITE EVIDENCE DEMONSTRATES THAT CORTICOSTEROIDS (OR ANY OTHER THERAPY) ALTER THE NATURAL HISTORY OF PMR. THE LOW DOSE CORTICOSTEROIDS USED IN PMR ARE ALMOST CERTAINLY INEFFECTIVE IN THE PREVENTION OF VASCULITIS PROGRESSION."

Under the heading of complications: "Generally, PMR is not associated with serious complications. Arteric replapse (ie GCA) relapse in a patient who presented exclusively with PMR is unusual.  However, every patient should be considered at risk for GCA."

'PATIENTS TREATED WITH CORTICOSTEROIDS ARE AT RISK FOR LONG TERM COMPLICATIONS OF CORTICOSTEROID THERAPY."

And finally, the best bit" "Inform the patient about the potential benefits and risks of corticosteroid treatment and encourage the patient to participate in choosing the treatment plan."



Chico, you are a wealth of information!  I read the article and was happy to hear that approximately 15%  with PMR develop GCA.  Wow, because I am on a low dose, it is significant to know that low dose pred. does not prevent progresssion of GCA.  SO, here we go again--it's that good drug / bad drug thing again. Hi Chico, Hi Marlene Hi Wildflower, Wildflower--I was diagnosed with GCA three years ago and then the PMR.  It started with an entire head pain not like any headache I ever had (and I had migraines for 30 years).  Sed rate was sky high, and 60 mg pred to start resolved the head pain.  After three years, I can pretty well tell when I'm getting a flare of the GCA, so I increase my pred without going to the Dr.  Another symptom of GCA is a painful jaw (claudication) where I can barely stand to chew anything to eat.  Also, changes in vision is another symptom (blurring, whiteout areas in vision, flashing zigzag lines).  Any of these things makes me increase my pred by 10 mg for a week or more.  I then start tapering again.  I'm on 5 mg right now.  The GCA also involves the internal vessels as well.  Weaknesses in the vessels in the abdomen causes deadly circumstances as well.  It weakens arterial walls and vessels from the inflammation.  Steroids can cause a weakening in the vessel walls as well.  My rheumy has cat scans done to see if anything internal is bulging. Hi all. Imainfp, thanks for sharing your story and warnings about GCA. It really is a scary thing. I hope yours goes soon and never comes back!

Your warning is very true, and all of us PMR people need to be very aware of the possibility of developing GCA.  Speaking for myself, I would definitely be taking my pred long term if I had, or had had, GCA. Good advice too about not waiting around to "see what happens" if you get the symptoms. I know that if I got anything like that I would be off to the doc or hospital the same day. I too have had migraines and I think I would know what is a different headache.

Donna, yes, it;'s really scary that GCA can affect the large vessels in the abdomen and heart.  I didn't know that pred could cause aneurysyms though. Fortunately, ultrasound is an affordable and simple way to look for that.
Hi Chico, Call me a cynic, but my theory why PMR has not had a lot of research done on it is that it is primarily considered an old persons disease and therefore not as important or interesting as other diseases that affect younger people or the whole age specturm. I hope I am wrong!

I noticed my skin thinning after just 5 months on low dose pred. So it does the same to your insides as well! Blimey! What's worse then, the effects of inflammation on the tissues or the effects of pred on the tissues??!!
Hello all,