Dr. Ashaq Hussain Parrey
Rheumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
One of my family members has been diagnosed with temporal arteritis. She has had a history of focal, temporal headaches for three days. There is no history of neuro deficits, visual changes, and no jaw claudication. During her routine bloodwork, ESR (erythrocyte sedimentation rate) was 20 mm/hr, and CRP (C-reactive protein) is pending and should return tomorrow. CBC (complete blood count), CMP (comprehensive metabolic panel), lipids, TSH (thyroid stimulating hormone), and urine analysis are all normal other than mild hypokalemia, likely due to diuretic. She has osteoporosis, so I would like to know if it would be wise to pull the trigger on treating her with steroids. And also, could you please suggest the latest imaging modalities for the condition?
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern. Before starting an old patient on high-dose steroids with significant side effects, one simple investigation that may help is arterial doppler, if the patient can do it. The one problem with temporal arteritis is it can cause sudden, irreversible vision loss. If she had high inflammatory markers with jaw claudication, I would suggest starting steroids, regardless of age. However, that is not the case here. I would suggest trying NSAIDs (non-steroidal anti-inflammatory drugs) like tablet Naproxen to look for signs of cervical spondylosis, a more common cause of cervicogenic headache at this age than temporal arteritis if the patient persists with symptoms, then I would suggest steroids and repeat ESR and CRP (C-reactive protein) if possible. Consult your specialist doctor, discuss with them and take medicines with their consent.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I am unsure if arterial doppler is available in my area, but I will certainly inquire. Thank you, doctor.
Hello,
Welcome back to icliniq.com.
Sure. Let me know if there is any issue.
Thank you and take care.
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Rheumatology
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