2 associated conditions related?

DEAR DR. ROACH>>

Your recent column featured polymyalgia rheumatica and prednisone. Would you please elaborate on how polymyalgia rheumatica can be linked to giant cell arteritis, and the consequences of not having a proper diagnosis in this regard? I had polymyalgia rheumatica two years ago with giant cell arteritis following almost immediately. This was promptly recognized by my primary doctor, confirmed by biopsy and treated with prednisone. It is hard to think that the painful upper arms and hips of polymyalgia rheumatica could lead to the instant blindness of giant cell arteritis if not diagnosed quickly enough. ANSWER>> Giant cell arteritis, also called temporal arteritis, is a condition associated with polymyalgia rheumatica that is certainly worth talking about. While only 10% to 15% or so of people with polymyalgia rheumatica will develop temporal arteritis, it’s dangerous, sometimes overlooked and has a rare permanent complication that you’ve already alluded to.

Giant cell arteritis is not generally seen in people under 50: It’s most common in people in their 70s. Women are affected more often, and those with a Scandinavian background are particularly at risk.

Fever, fatigue and weight loss are nonspecific symptoms but they are prominent in giant cell arteritis. Headache, especially a new headache, is a big red flag. While classically the headache is worst over the temples, it does not have to be. The other suggestive symptom is “jaw claudication”: a sensation of difficulty chewing after doing so for a while, relieved by rest.

When all the symptoms are present in a person with polymyalgia rheumatica, the diagnosis is easy. Unfortunately, some people have only nonspecific symptoms, and it requires a sharp doctor with a high index of suspicion to consider the diagnosis.

The feared complication is vision loss, which is usually painless and sudden, and can be partial or complete. In cases where there is high suspicion, a person is usually started on high-dose steroids while a biopsy is being planned.

The biopsy will remain positive for at least two weeks after starting steroids, and since vision loss can be prevented by steroids.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.