Can you have GCA even though sed rate and mri is fine

[orange22]

Gca

[DorsetLady PMRGCAuk volunteer]

Short answer -yes!

Symptoms are the key. Up to 20% never have raised markers.

Why do think you have GCA?

[orange22 in reply to DorsetLady]

have headaches for months.

[DorsetLady PMRGCAuk volunteer in reply to orange22]

Okay, any other symptoms - shoulders,neck, jaw, difficulty in chewing/eating, fatigue?

[orange22 in reply to DorsetLady]

no

[DorsetLady PMRGCAuk volunteer in reply to orange22]

I would query then whether it is GCA. It could be, but as PMRpro rightly says there’s usually a lot more besides.

[PMRpro Ambassador in reply to orange22]

There are many causes of headaches - and they are only one symptom of GCA. It is the entire picture that is suggestive.

[SnazzyD]

Yes. The experts will be here with some stats but a certain number of people have normal inflammatory markers with full blown symptoms. Mine were normal with textbook symptoms and even when my sight was shutting down. However, my ESR, although was in the normal range, was high for me but the docs didn’t bother with that. I wasn’t aware MRI was a diagnostic tool for GCA and done more to rule things out. Even an artery biopsy can give a false negative as it did with me. If you get a positive though, you know it is. A less invasive and debatably more reliable test, in the right hands, is the ultrasound of the artery. Both the last two tests can be made falsely negative by starting the Pred before doing them, though opinion on how long for seems to vary. Priority should always be given to protecting sight than hanging about for an appointment for the test.

In the case of everything negative/normal they have to treat the symptoms because not to do so can risk the patient ‘s eyesight. On that note, my eye check was ok even then. If they respond fairly quickly to the administration of steroids (providing the dose is high enough!), that is even more evidence pointing to GCA. All a bit unsatisfactory but there it is right now.

[PMRpro Ambassador in reply to SnazzyD]

ard.bmj.com/content/77/5/636

"High resolution MRI of superficial cranial arteries should be considered as an alternative to ultrasound. The diagnostic value of both modalities is comparable (pooled sensitivity of MRI: 73%; specificity: 88%).12 Similarly, a retrospective direct comparison of MRI and ultrasound revealed a similar sensitivity (69% and 67%, respectively) and specificity (both 91% and 91%) of both techniques.32

The main limitations of MRI are restricted availability, costs and possible adverse effects of contrast agents. MRI might only be feasible if emergency referrals for GCA can be implemented. It is strongly advised not to delay GC therapy due to outstanding imaging, and MRI of cranial arteries needs to be performed immediately within the first days of GC therapy in order to avoid false-negative results.

The advantages of MRI over ultrasound are a higher standardisation of data acquisition and the possibility to investigate multiple cranial and extracranial arteries including the aorta at the same time, which might reduce the probability of missing inflammation in case of skip lesions. This requires specific technical settings with multiple coils and a long time on the MRI scanner, which is not always feasible. MRI can also assess intracranial arteries, which may be affected in GCA." (my bold type)

[PMRpro Ambassador]

Had you already been on any pred before the MRI was done? And was it a very long MRI done with contrast medium?

[orange22]

No contrast and no meds