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Suggest medical tests to rule out GCA

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Posted on Thu, 5 May 2016
Question: I have been taking steroids for two years for GCA and PMR, got down to 2mg and had a flare with PMR and put back up to 50mg, have now got it down to 7mg and suffering from pain in left temporal. Had an ultrasound today which came back ok but the consultant said that I am showing all the signs of GCA again and my CRP has gone up slightly. He has now put me back onto 40mg. Is it possible that even though the ultrasound showed nothing that I could still have GCA? Kind regards
doctor
Answered by Dr. Binu Parameswaran Pillai (5 hours later)
Brief Answer:
GCA.

Detailed Answer:
Good day,
Giant cell arteritis and PMR are closely related. Often GCA is difficult to diagnose with ultrasound. The follow up is largely based on your symptoms, CRP /ESR levels.
So you could still be having GCA with a normal ultrasound. I hope you are being followed up by a rheumatologist.

Regards
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai (36 hours later)
Had ultrasound which came back ok. Consultant has put steroids up to 40mg daily as he said all my symptoms are showing flare up of Giant Cell Arteritis. I have been on steroids for two years and every time I manage to get them down it's either GCA or PMR. My CRP has gone to 6 but my ESR has jumped from 5 to 33
doctor
Answered by Dr. Binu Parameswaran Pillai (7 hours later)
Brief Answer:
Need prophylaxis agaist osteoporosis

Detailed Answer:
ESR of 33 is little high. Prednisone need to be continued for a longer time in larger doses to acheive remission. Sometimes, intravenous high dose steroids for few days are helpful for rapid control. I hope you had a temporal artery biopsy earlier.

You should also take Calcium 1000 mg per day and vitamn D 1000 to 2000 units a day to protect the bones from osteoporosis while on long term steroids. In addition, your doctor should give you bisphosphonates (Fosamax/alendronate) for bone protection.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1435 Questions

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Suggest medical tests to rule out GCA

Brief Answer: GCA. Detailed Answer: Good day, Giant cell arteritis and PMR are closely related. Often GCA is difficult to diagnose with ultrasound. The follow up is largely based on your symptoms, CRP /ESR levels. So you could still be having GCA with a normal ultrasound. I hope you are being followed up by a rheumatologist. Regards Binu