Should I have temporal biopsy for GCA even after 8 weeks prednisone?

Posted by sophie @sophies, Mar 9 11:46am

I was diagnosed with PMR eight weeks ago. Sed rate was only 32 and CRP was 12. I started prednisone at 20MG for 1 week, then 15 MG for 19 days then 12.5mg for another 19 days as advised by my primary care DR. Now I have finally gotten in to see rheumatologist but I have concern about temporal headaches. Unfortunately, I cannot remember if they started before the prednisone. Anyway, Rheumatologist wants to check for GCA with biopsy and I would rather less invasive ultrasound. According to what I have read, it would seem that both tests would be compromised because of steroid use. And, with negative results, do you take a chance and believe there is no GCA? I don't currently have any otherGCA symptoms. Any thoughts or advice would be so appreciated.

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gonzalescb70 | @gonzalescb70 | Mar 21 5:38pm

I’ve thought about that for myself however, the treatment doesn’t change even if a biopsy confirms GCA. For me, I chose to just do the steroid therapy. Also, if you’re already on steroids, it may not be reliable i.e. there may be no giant cells in the artery to observe. I’d do noninvasive methods and take the steroids.

greyson70 | @greyson70 | Nov 20 7:21am

How did your ultrasound go? My relative may have GCA but, in our city, no one specializes in doing temporal artery ultrasound. I wonder if that is common. Ultrasound is preferable to an invasive biopsy on the face.

mark1952 | @mark1952 | Nov 20 9:36am

Hello, Sophie, et al,
Once again I am so glad that I found this discussion on Mayo Clinic connect. I have been having very localized headache pain in my left temple for about 4 months now. It started out very minor and intermittent and continued to be very minor for 2 or 3 months. But within the last month, I had a two-week session of having more painful temple pain and imbalance and blurry vision. Those have pretty much subsided but I still have the fairly minor pain in my temple. I can make it hurt by gritting my teeth, or sleeping on that side of my head (because I am a side sleeper), rolling my eyes up towards that temple, deep coughing, or even straining in the bathroom. My primary is out of the country on vacation but thankfully he called in the relevant tests and all of my tests would really not indicate GCA, for example, my erythrocyte sedimentation rate is just 2 mm per Hr. My C reactive protein, or CRP, is less than 0.3 mg per deciliter. My MCH value is just very slightly high at 33.6 and my MCHC is just very slightly high at 35. My platelets count is normal at 147. So I saw an ophthalmologist yesterday and he basically didn't know what to make of things. He didn't see any problems with my eyes and he said that usually when he has a patient with GCA that the numbers on those tests are very elevated. He kindly gave me a referral to a rheumatologist that I will see next week and hopefully they can decide on a course of action. And I see my pcp's nurse practitioner tomorrow to see what my PCP might be thinking. Any suggestions for how to proceed would be appreciated.

mark1952 | @mark1952 | Nov 20 9:42am

P.S. My ophthalmologist also said that usually with his patients with GCA that the artery in the temple is enlarged, sometimes warm, and quite firm to the touch, and when he touched my temple he did not feel anything like that so this is a bit of a mystery.