Biopsy only way to diagnose blinding disorder


Q: My doctor has made a tentative diagnosis of temporal arteritis and has referred me to a surgeon for a biopsy of an artery on the side of my face. I am reluctant to follow his advice because my only health problems at age 75 are some headaches and increased tiredness. Why would I need a biopsy?

A: Temporal arteritis, also known as giant cell arteritis, is a disorder caused by an unexplained inflammation of the arteries, most often those supplying the scalp and eyes. Narrowing of the arteries by the inflammation can decrease the blood supply to tissues and cause headaches, pain and tenderness in the scalp, pain when chewing and recurrent, but transient, blurring or loss of vision. Left untreated, the disorder may cause blindness.

Giant cell arteritis (GCA) may be one of the manifestations of a more widespread syndrome called polymyalgia rheumatica (PMR). PMR is characterized by the rather sudden onset of a constant aching pain and stiffness involving primarily the muscles of the shoulders, upper arm, neck, thighs, hips and lower back. Other possible symptoms include easy tiredness, loss of appetite and weight, low-grade fever and pain in some of the large joints. GCA and PMR are more common among women and whites. They rarely occur before age 50. Frequency increases with age.

PMR tends to subside within two or three years even without treatment. During the active stage of the syndrome, symptoms respond promptly to low doses of corticosteroids, usually prednisone, and more slowly to nonsteroidal, anti-inflammatory drugs.

The diagnosis can only be made with certainty through biopsy. The biopsy, done under local anesthesia as an outpatient, is safe because the rich blood supply to the region is not significantly affected by removal of a small piece of blood vessel.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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