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Suggest Treatment For Temporal Arteritis
Question: My sister was not feeling well for approx 3 months.Headaches,general fatigue and other symptoms. Aprrox 19 days ago she woke with swelling in her forehead and immediately went to her internist. He put her on prednisone right away and she saw a neurologist who scheduled a biopsy last Thursday. Yesterday she was told it was positive for temporal artitis. She seeing her neurologist tomorrow. She is supposed to fly frm NY to Fl 3/9 and it concerns me greatly. I am extremely upset and am concerned she will not discuss all of this with her DR. Please advise. Thank you!
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I appreciate your concern about your sister.
Temporal arteritis is a condition which if left untreated can have serious repercussions, from blindness to even death so attention is needed.
The good news though is that when it's detected in time before serious complications have occurred it responds well to therapy with steroids, most patients recover completely from the condition.
However there is the issue of steroid therapy. It is continued for a long term (2 years most commonly - although the dose will be tapered after 4-6 weeks) and it can have its fair share of side effects especially in the elderly, particularly osteoporosis. So perhaps she should be under calcium and vitamin D for osteoporosis prevention as well as something for stomach protection.
So while the prognosis for temporal arteritis is good it is essential to have regular follow-up up visits both for evolution of symptoms and for screening for side effects of medication, usually after 1, 3 and 6 weeks initially, and every 3 months later (numbers may change somewhat in different countries and practices). It is essential that your sister understands that she shouldn't hide anything from doctors, if things go according to plan she won't have to alter her lifestyle, but should check regularly.
The visit with the neurologist is scheduled I suppose to screen for involvement of brain vessels.
If no such involvement is found and she seems to respond well to therapy (improvement is seen often in a matter of days) I do not think there is any obstacle for her to go on the planned trip.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I appreciate your concern about your sister.
Temporal arteritis is a condition which if left untreated can have serious repercussions, from blindness to even death so attention is needed.
The good news though is that when it's detected in time before serious complications have occurred it responds well to therapy with steroids, most patients recover completely from the condition.
However there is the issue of steroid therapy. It is continued for a long term (2 years most commonly - although the dose will be tapered after 4-6 weeks) and it can have its fair share of side effects especially in the elderly, particularly osteoporosis. So perhaps she should be under calcium and vitamin D for osteoporosis prevention as well as something for stomach protection.
So while the prognosis for temporal arteritis is good it is essential to have regular follow-up up visits both for evolution of symptoms and for screening for side effects of medication, usually after 1, 3 and 6 weeks initially, and every 3 months later (numbers may change somewhat in different countries and practices). It is essential that your sister understands that she shouldn't hide anything from doctors, if things go according to plan she won't have to alter her lifestyle, but should check regularly.
The visit with the neurologist is scheduled I suppose to screen for involvement of brain vessels.
If no such involvement is found and she seems to respond well to therapy (improvement is seen often in a matter of days) I do not think there is any obstacle for her to go on the planned trip.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
What if there is involvement with brain vessels? Does that change the outlook considerably? Also,should she fly so soon after it has been diagnosed.Does the medicine not need to be regulated? Is it a problem being so far from her DRs.Thank you for your patience.
Brief Answer:
Read below
Detailed Answer:
If there is nervous system involvement initial dose may be higher. Also if she has developed some neurological deficit like a decline in her higher mental function (due to vessel damage with small widespread strokes) those issues may remain even if therapy is successful, therapy stops progression but can't reverse an established stroke. But if she hasn't developed any deficit till now she should still respond well to therapy as I said before.
As for flying it doesn't affect the course of the disease. Most patients are treated as outpatients, rarely admitted to hospital. So if her condition is good, with no visual or mental deterioration to impair her functioning (with treatment hopefully even better at that time) and it is a short lasting trip which doesn't represent an obstacle to her having follow up visits at her return I wouldn't forbid her to make the flight. The dosage of the medicine for the first 4 weeks is generally the same anyway, afterwards lowering is started. If she means to stay for many weeks on the other hand I agree with you that it is not advisable, not unless she finds a doctor to take charge of her rightaway.
I hope to have been of help.
Read below
Detailed Answer:
If there is nervous system involvement initial dose may be higher. Also if she has developed some neurological deficit like a decline in her higher mental function (due to vessel damage with small widespread strokes) those issues may remain even if therapy is successful, therapy stops progression but can't reverse an established stroke. But if she hasn't developed any deficit till now she should still respond well to therapy as I said before.
As for flying it doesn't affect the course of the disease. Most patients are treated as outpatients, rarely admitted to hospital. So if her condition is good, with no visual or mental deterioration to impair her functioning (with treatment hopefully even better at that time) and it is a short lasting trip which doesn't represent an obstacle to her having follow up visits at her return I wouldn't forbid her to make the flight. The dosage of the medicine for the first 4 weeks is generally the same anyway, afterwards lowering is started. If she means to stay for many weeks on the other hand I agree with you that it is not advisable, not unless she finds a doctor to take charge of her rightaway.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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