Polymyalgia Rheumatica and Giant Cell Arteritis (cont.)
IN THIS ARTICLE
Corticosteroid medicine is the most common treatment for both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). People with either or both conditions usually have fast relief of their symptoms soon after starting corticosteroid treatment.
Corticosteroid medicine treats both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). In general, you will use the corticosteroids at a certain dose until your symptoms go away and your lab tests are normal. When this occurs, your doctor will gradually begin reducing your medicine.
For polymyalgia rheumatica:
For giant cell arteritis:
How long you need to take corticosteroids depends on how severe your condition is, whether it appears cured or not (remission), and how often you have relapses. Some people are not able to completely stop taking corticosteroids. If this happens, your doctor may suggest another medicine such as methotrexate to help control your symptoms and keep the condition from coming back.
After your symptoms have gone away and your laboratory tests are normal, ongoing treatment for polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) usually includes continued use of corticosteroid medicine.
Your doctor gradually lowers the amount of medicine you take. How quickly he or she does this varies with the individual.
If your symptoms do not improve with corticosteroid medicine, your doctor may need to test you for other conditions that are similar to polymyalgia rheumatica or giant cell arteritis.
Your doctor will track your condition while you are taking corticosteroid medicine and for 6 to 12 months after you stop taking the medicine. This tracking may include regular appointments or telephone calls to discuss your symptoms and tests to measure your erythrocyte sedimentation rate (ESR) or your C-reactive protein (CRP) value.
If you need long-term corticosteroid treatment for either condition, you are at risk for bone thinning (osteoporosis). This is because corticosteroids decrease how well your body takes in calcium, which is important in building strong bones. Your doctor may recommend a bone density (DEXA) test to see if you need medicine (bisphosphonates) to prevent osteoporosis. Or he or she may simply start you on bisphosphonates without the test. For more information, see the topic Osteoporosis.
Treatment if the conditions get worse
In both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), your symptoms may return (relapse) after a period of improvement. This often occurs in the first 2 years of treatment or during the first 12 months after you stop taking corticosteroid medicine. A relapse usually occurs if the dose of corticosteroids is reduced or withdrawn too quickly. But up to 50% of people with either condition have a relapse over the first 2 years that is not related to how corticosteroids are used.2 If you have a relapse of symptoms, your doctor will increase the corticosteroid dosage for a period of time, then gradually decrease it after your symptoms are gone.
In rare cases, giant cell arteritis can affect the main part of the aorta in the chest, rather than one of its smaller branches, causing an aortic aneurysm. If this were to happen, you would feel severe chest pain that could extend to your back, and you could faint or have symptoms of a stroke. If you have giant cell arteritis and have such symptoms, contact your doctor or call
Giant cell arteritis can lead to partial or complete loss of vision in one or both eyes. If you have sudden onset of double, blurred, or "browned-out" vision, or temporary loss of vision, your doctor may increase your corticosteroid dose. And for a few days he or she may give you the dose directly into a blood vessel (intravenously) to try to prevent permanent or further loss of vision.
What to think about
If you have polymyalgia rheumatica and do not have giant cell arteritis, your doctor may suggest using nonsteroidal anti-inflammatory drugs (NSAIDs) when you are lowering the dose of your corticosteroid medicine. Always talk to your doctor or nurse before using these medicines.
Some doctors recommend taking aspirin if you have giant cell arteritis. This is because some studies show that doing so may reduce the risk of vision loss, stroke, or transient ischemic attacks (blood flow to the brain is interrupted).3
Corticosteroids can cause serious side effects, including high blood pressure (hypertension) and bone thinning (osteoporosis). If you are taking long-term corticosteroids to treat polymyalgia rheumatica or giant cell arteritis:
Methotrexate, or other medicines that suppress your immune system, may be used for polymyalgia rheumatica or giant cell arteritis alone or with corticosteroids to reduce the corticosteroid dose and limit its side effects. Research results are mixed on how effective this treatment is.4
Giant cell arteritis sometimes affects the large arteries of the arm. In rare cases, this interferes with blood flow. This can cause pain and cramping when you use your arm. In a small study, balloon angioplasty opened up the arteries of the arm to decrease symptoms of giant cell arteritis.5
eMedicineHealth Medical Reference from Healthwise
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