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Awaiting GCA diagnosis biopsy
In a second PMR flareup. Woke with swollen jaw hinge. Rheumatologist has me scheduled for a biopsy with an ophthalmologist. At my annual visit yesterday my optometrist seemed surprised that they weren't doing an ESR first and that an ophthalmologist would be doing a biopsy. I had told him about the PMR, blood tests, etc. Was he not listening, am I missing something., or is he in need of a little "education"?
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While both specialties are called "doctors" the training is very different. Ophthalmologists have 12–14 years of training, including medical school and surgery. Optometrists complete a 4-year optometry degree.
Ophthalmologists, General Surgeons, and Vascular Surgeons are equally capable of performing temporal artery biopsies. Checking ESR and CRP levels is a standard practice when GCA is suspected but symptoms of GCA carry the most weight. Symptoms of GCA is especially true when a patient has a history of PMR. Even a temporal artery biopsy can be falsely negative.
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1 ReactionI self diagnosed my GCA in February after waking Jan 14th with 8/10 bilateral jaw pain that continued nightly for weeks. I also had bilateral temple, TMJ and nuchal line pain. No headaches, which is what my PCP was looking for. My research revealed the Maxillary arteries are often involved. After 5 weeks of unrelenting pain, I said,"This is basis for GCA testing". PCP agreed and had me come in for bloodwork, increased my pred from 10 to 40mg and set me up with a vascular surgeon. My ESR had spiked from 2 to 17 but CRP remained at 9. Right temporal artery biopsy March 9th was positive for GCA. I had an Actemra infusion March 17th. I am now on weekly self injections of (insurance driven) Tyenne. So far, so good. I am a retired P.T. and feel strongly about researching everything a medical person tells me, if I don't know better. Just because the person is a doctor, doesn't mean they know what they are talking about. I urge you to find the best specislist you can. And as dadcue said, the artery biopsy can be false positive or false negative; however, it is the gold standard for GCA diagnosis. GCA can have life altering irreversible visual effects and needs immediate attention if suspected.
I pray you get the help you need!