Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The diagnosis of giant cell arteritis is suspected when a
patient over
the age of 50 (usually over 60) develops symptoms
above
and/or suddenly develops blindness or stroke. The diagnosis is
supported
by signs of inflammation in the blood indicated by an elevation
in the
erythrocyte sedimentation rate (ESR) and/or C-reactive protein.
The diagnosis is confirmed with a biopsy of an artery, usually an artery on the side of the scalp called the temporal artery. This biopsy is performed under
local
anesthesia in an outpatient setting. It requires an incision
into the
scalp over the artery in the skin. The tissue of this area is
supplied by
blood from many vessels and does just fine after removal of the
piece of
the artery.
How is giant cell arteritis treated?
The goal of the treatment of giant cell arteritis is to
suppress the
inflammation within the arteries. When giant cell arteritis is
diagnosed,
high doses of cortisone medications, either intravenously or by
mouth are
necessary. The high doses required to quiet the inflamed
arteries
frequently are associated with side effects, including sweats,
weight
gain, bruising, puffiness of the face, erratic emotions, and
others. (For
more information about the effects of cortisone medications,
please read the prednisone
article.)
Also, in order to maintain optimal blood flow, low-dose aspirin is often given to optimize circulation of blood and prevent unwarranted blood clotting within diseased arteries. Recent studies have shown that low-dose aspirin can reduce the risk of stroke and visual loss in patients with giant cell arteritis.
As in the treatment of polymyalgia rheumatica, because the cortisone medications are associated with potential bone toxicity, causing osteoporosis, patients should consider calcium and vitamin D supplementation. Women should have bone mineral density testing, and osteoporosis medications, such as estrogen, alendronate (Fosamax), and risedronate (Actonel) are considered.
Polymyalgia Rheumatica - Symptoms At Onset Of DiseaseQuestion: The symptoms of polymyalgia rheumatica can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
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