Giant Cell Arteritis

[sharonspmr]

I have had Polymyalgia Rheumatica for 1 1/2 yrs.  a few months ago I had several bad headaches and my eye sight deteriorated.  An eye exam showed a loss of 2??.  I asked if it could be GCA and he said, no your eyes look fine.  Just not sure why your sight was worse.  In the last two weeks I have had 4 days of bad headaches.  Across the front of my head, down behind the eye and my teeth or gums ache.
Two days ago, I noticed when pushing my pin number on a debit machine, I could not see the numbers.  They were blurry.  I have had days without headaches, so then I think I am jumping the gun..but tonight I have a pounding headache  on the front right side, down into my eye and bottom jaw.  Does GCA ease up at times?  Come and Go?  If you were to have a biopsy done, does it have to be when I am having a bad headache ect?

[Houman Vosoghi, MD]

You are at high risk for GCA and need some lab work done right away.  An ESR and CRP are very sensitive for picking this up and if still in doubt after that, a biopsy may be necessary (this could be done anytime and should be positive if you have the disease).  Your symptoms could also be consistant with angle closure glaucoma so you definitely need to see an ophthalmologist right away who could check your eyes for both of these conditions.  GCA usually has jaw claudication (ache after chewing), headache, scalp tenderness (hurts when you brush your hair), + symptoms of polymyalgia rheumatica.  Angle closure glaucoma presents with eye ache, headache on same side, blurry vision, halos around lights, and sometimes nausea and vomiting.  There are other facial, neurologic, and dental causes potentially of the pain you describe; however, given your history of PR, I would want GCA and angle closure glaucoma ruled out immediately by an ophthalmologist.  You could worry about other less emergent causes later if tests are negative.  Do not delay!

HV

[sharonspmr]

Unfortunately, I went into emerge yesterday morning.  9 a.m.. At 1 p.m. taken into an examination room.2:45 p.m.  Intern came in and I told him all my symptoms and that I had a headache, although settled alot since last night.  He did blood tests and thought it may be my heart.  The sed rate came back 27 (which is elevated for me) Two weeks earlier it was 26. (ESR was 61) Intern said ESR means nothing, it is the sed rate that determines if it is GCA.
He said if it was GCA I would be blind and unable to sit up or move due to pain.  I replied I am being treated for PMR and that is why I can move. (although I hurt in chest muscles, knee, in upper legs and shoulders each morning.)  He said I just need to wear my glasses and sent me home.  I am going to inquire about being sent somewhere in Canada, where they know what they are doing.  I hope I can get someone here to agree to this and refer me.
Thank you so much for your information.  It has made me a little more sure that this isn't just something to sweep under the rug.  Thank you again.  Wish I lived in the UK.