Polymyalgia Rheumatica (PMR) & Giant Cell Arteritis (Temporal Arteritis)

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    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.

  • Medical Editor: Catherine Burt Driver, MD
    Catherine Burt Driver, MD

    Catherine Burt Driver, MD

    Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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What is the treatment for giant cell arteritis?

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, insomnia, and others.

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. 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. Appropriate patients should have bone mineral density testing, and osteoporosis medications, such as estrogen, alendronate (Fosamax), and risedronate (Actonel), are considered.

What is the prognosis for patients with giant cell arteritis?

Giant cell arteritis usually runs a self-limited course, over months to years. Rarely, the inflammation may not respond to high doses of cortisone, and stronger medications that suppress the immune system have been tried, such as methotrexate (Rheumatrex, Trexall). In most patients, the cortisone medications can gradually be tapered according to the symptoms while the ESR blood test is monitored.

The effects of the arteritis depend not only on the amount of inflammation in the arteries but also on the location of the arteries in various body tissues. Research scientists studying arteritis have discovered that the location of the inflamed arteries in the body and whether it is associated with polymyalgia rheumatica seem to relate to different features of specialized white blood cells (T cells) that are infiltrating the artery walls. If these T cell differences can be further classified according to the patterns of inflammation in patients, this could lead to a new era of "customized" treatments for giant cell arteritis.

Medically Reviewed by a Doctor on 3/7/2016

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