Do oral steroids cure temporal arteritis or just reduce complications/
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Do oral steroids cure temporal arteritis or just reduce complications/
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I have a number of elderly patients diagnosed with temporal arteritis [not all of whom have had temporal artery biopsies]. generally they have presented but headache and have had very high
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Do oral steroids cure temporal arteritis or just reduce complications/
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Do oral steroids cure temporal arteritis or just reduce complications/
posted at 28/3/2012 7:32 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
I have a number of elderly patients diagnosed with temporal arteritis [not all of whom have had temporal artery biopsies]. generally they have presented but headache and have had very high Plasma viscosities and C reactive protein blood tests. But the steroid doses suggested from the local hospital have been very high doses of steroids , 60mg a day. with most of my elderly patient this has produced not just the Cushingoid face and weight gain but significant diabetes. I presume that oral steroids are meant to reduce the risk of optic artery thrombosis and blindness, and that one is hoping in a year or two that the presumably autoimmune arteritis subsides. My inclination is to reduce steroid doses if inflammatory markers get better. My I don't like to see my patient get worse from medication that I am prescribing. Would temporal arteritis get better [even with more risks of blind ness] if un treated. I suppose it would be un ethical to try too find out. Any pearls of wisdom as to how I should treat these elderly patients would be most welcome |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 29/3/2012 12:28 AM BST
on bmj.com
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Posts: 577
First: 8/6/2011 Last: 18/5/2013 |
Hello Pat ! Thanks for the interesting problem. |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 29/3/2012 1:14 AM BST
on bmj.com
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Posts: 577
First: 8/6/2011 Last: 18/5/2013 |
And these is from the app of epocrates for iphons ; prednison is given 1 mg/kg/day orally for 4 weeks , maximum 80 mg ; gradually taper dose over 6-12 months . Durtion of treatment varies according to symptoms and inflammatory markers . Dose of prednisone is reduced as soon as possible to minimize total dose , but only once inflammatory markers have normalized. Relapses on reducing the dose are common , and most patients require corticosteroids for at least 1 to 2 years or longer. Also you should think about aspirin and osteoporosis prevention. And here is again methotrexate for those whom tapering corticosteroid therapy is impossible due to recurrence of symptoms or who experience or are at particularly high risk of corticosteroid-related adverse effects. Methotrexate may reduce corticosteroid requirements for disease control and may lower the risk of relapse. And a last notice by me i would look to confirm the diagnosis with a biopsy . Biopsy can be done up to 2 wk or perhaps more after treatment is started becouse the inflammatory proces is slow to resolve. |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 29/3/2012 1:33 AM BST
on bmj.com
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Posts: 577
First: 8/6/2011 Last: 18/5/2013 |
I don't now if i helped you but i really like very much these real problems of the clinical practice . I hope more doctors will presend for discussion problems like that and a lot more will participate to the discussions on '' real medicine'' |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 29/3/2012 12:37 PM BST
on bmj.com
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Posts: 339
First: 17/12/2011 Last: 15/5/2013 |
Ikaros Thank you. I have added the Merc Manual to my favourites. One of those affected is my wife , the lady on the right of my picture. So I have a keen interest in temporal arteritis at the moment ! She is struggling with diabetes and other steroid side effects, but coping. The Opthalmic surgeons are thinking of implanting a local steroid in her eye , very expensive treatment but we hope it will reduce the risk of further visual loss. She doesn't want to have this [if available] until we have a holiday in late April when we go to our apartment in Portugal. Illness in one's self or ones family makes one take a keener interest in particular diseases! She is on aspirin [she also has Hughes syndrome aka sticky blood] , insulin, bone protection etc , etc. She was on azothiaprine but she was so sick she had to stop this. |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 29/3/2012 2:39 PM BST
on bmj.com
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Posts: 1258
First: 13/4/2010 Last: 18/5/2013 |
Pat - my understanding is that steroids don't "cure" - they reduce the inflammatory response and need to be continued for 1 - 3 years after reducing to a stable dose. By then the condition has often "burnt out" but sometimes relapses do occur so ongoing vigilance is needed. |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 7/4/2012 4:31 AM BST
on bmj.com
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Posts: 27
First: 25/9/2011 Last: 13/2/2013 |
There is no "cure" for Temporal Arteritis but when you think about it that's true for most of our medical conditions, ie we just manage/control them. The issue with Temp arteritis, I think, is that if you suspect it there should be a local policy of being able to do biopsies within 2-3 weeks so that the diagnosis can be confirmed. Steroids must be started prior to biopsy confirmation to reduce the risk of permanent visual loss but a negative biopsy will give you much greater confidence in getting the dose of steroids down more quickly. We use CRP almost exclusively in New Zealand as ESR is considered outdated and expensive ( in terms of time taken). In my experience anaemia is also common with Temporal arteritis and unlike the CRP does not improve much with steroid treatment. The big problem with Temporal arteritis is the shared pathology with Polymyalgia that can be managed with much lower doses of steroids and considering the length of time you have to treat people for ( usually > 2 years) the lower the total cumulative dose of steroids given the better. |
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Re: Do oral steroids cure temporal arteritis or just reduce complications/
posted at 7/4/2012 5:04 PM BST
on bmj.com
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Posts: 577
First: 8/6/2011 Last: 18/5/2013 |
What is your opinion about the combination of medical treatment of temporal arteritis with baths in thermal springs ? Has anybody any experience on this ? |
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