Will there be serious side effects from the steroids I’m taking?

I HAVE been diagnosed with a blood condition called giant cell arteritis. My GP prescribed 50mg of steroids while I wait to see a specialist, but I’m worried about the side effects. This dose seems high. Is it normal?

GIANT cell arteritis happens when arteries, usually those at the side of the head, become inflamed, causing severe headaches and vision problems.

Rapid treatment is vital to prevent further sight loss or pain spreading to the neck and shoulders, which happens to roughly half of patients.

A GP will initially diagnose the condition via a blood test that spots signs of inflammation. A referral to a rheumatologist can be made, but it’s not usually necessary to confirm a diagnosis before starting treatment and, in severe cases, a concerned GP might immediately prescribe high doses of a steroid called prednisone.

Many patients find the side effects of steroids difficult to bear – constipation is very common, as is indigestion and excessive sweating. Long term, steroids can suppress the immune system and increase the risk of osteoporosis.

But the high dose of prednisone for giant cell arteritis patients is short-lived – usually just a couple of weeks to get symptoms under control. A GP will reduce this to a much lower dose, lessening the likelihood of side effects.

A small number of people may need to take steroids for the foreseeable future, and will be monitored closely. At this point, a rheumatologist can suggest other medications and treatments to counter the side effects of steroids, or explore non-steroid options. Very severe side effects – particularly weight gain in the upper back, a puffy, rounded face, severe stomach pain or feeling faint – are uncommon but warrant an urgent call to NHS 111.

I HAVE polymyalgia in my right shoulder and the pain often stops me sleeping. I have read that cannabis oil can help to ease discomfort and send me to sleep. Will it help?

CANNABIS-based medical products are made from chemicals derived from the cannabis plant, and don’t induce psychoactive effects. They come in oral solution or nasal spray form, and there are only three situations in which a doctor would recommend them – otherwise, doctors do not prescribe them.

The first is to treat epilepsy that can’t be controlled with other drugs, as some studies have shown it may be effective in reducing the frequency of seizures. It may also be prescribed for vomiting triggered by chemotherapy, or to ease multiple sclerosis spasms.

Polymyalgia is a condition whereby an over-reaction of the immune system causes inflammation in the muscles and connective tissues. Cannabis-based medicine is not a recommended treatment.

Speak to your GP, as steroids are usually the first line of action to control symptoms. Trouble sleeping is common in polymyalgia, due to the agonising muscle pain.

One thing to try would be a strong painkiller, such as co-codamol, which makes you sleepy. Again, only take this under medical advice. Improving your bedtime routine can help, too – keep phones out of the bedroom and try some deep-breathing exercises.

There are over-the-counter tinctures containing cannabidiol (CBD), which is a cannabisderived chemical. There’s little evidence for it doing anything, despite what’s claimed online. Having said that, you could try it, as it’s not likely to cause any harm. Check with a local pharmacist before doing so, though.

ROUGHLY 20 years ago I had an operation to remove nasal polyps, but after seven years they came back. Now I’m often bunged up. I’ve used sprays that are supposed to wash out your nose, and other decongestants. Nothing works, and I’m regularly prescribed steroid tablets, which help but not for long.

Can you offer any advice?

NASAL polyps are painless little fleshy growths inside the nose. You can’t usually see or feel them, and they’re not often a reason for concern, but if they grow too large they can begin to cause problems.

A constantly blocked or runny nose, a feeling of needing to swallow all the time – a condition called post-nasal drip – and a reduced ability to smell and taste are all signs of nasal polyps. Problems breathing through the nose, snoring and nosebleeds are also common symptoms.

It’s not totally clear why people develop them, but they are sometimes seen alongside asthma and aspirin sensitivity – a reaction to the painkiller that causes wheezing and an itchy rash or hives.

Polyps can be quickly diagnosed by a GP who will look up the nose, with the help of a small torch, to see what’s going on.

In the first instance, many people try over-the-counter remedies to alleviate congestion, while prescription steroid nose drops or a spray can help to shrink them.

If this doesn’t work, or if the polyps are large, then steroid tablets may be prescribed.

If things don’t improve after ten weeks, a referral to an ear, nose and throat (ENT) specialist may be required.

They may recommend surgery – a polypectomy. It’s done through the nostrils, so there are no incisions, but it does require a general anaesthetic. It usually takes a few months before any difference is noticed. While the operation is effective, polyps often grow back, but using a steroid spray after surgery can help to prevent or slow any recurrence.

However, it’s important, if symptoms begin again or change, to get a new ENT referral.

Just because the problem was polyps last time, it doesn’t mean it is again. Although rare, certain types of cancers in the nose can look similar. Cancer becomes more common the older you are, so it’s always important to rule it out. Currently, operations for simple polyps might be delayed, due to Covid, but not cancelled altogether. It’s important to persist with your GP.