To take or not to take?

[garden49]

I was diagnosed with PMR and GCA in 2018 and have only managed to get to 5mgs of Preds without a flare. I have not seen the Rheumatologist for 18 months. When I last saw him he said I had to continue on Disprin 75 mg or I would have a stroke. My GP thinks I should stop them . Some time ago I went to a lecture given by Professor Das Gupta and he said he doesn’t prescribe them. My platelets are usually on the low side. I would be grateful to know what your experience has been. I have learnt more about my condition from this forum than anywhere else. Thank you all for your support.

[DorsetLady PMRGCAuk volunteer]

Low dose aspirin used to be recommended for patients with GCA (I was already on it in 2012 when I started Pred,so continued until 2016) - but advice seems to have changed over the years.

This was published in 2020 - Extract from Treatment of GCA on Uptodate site

“Anti platelet therapy —

In view of the conflicting observational data, the use of low-dose aspirin in patients with newly diagnosed GCA should be guided by current recommendations for the management of atherosclerosis [9]. If low-dose aspirin is used, a proton pump inhibitor should also be administered as aspirin, age, and high-dose glucocorticoids are all risk factors for gastrointestinal bleeding. (See "NSAIDs (including aspirin): Primary prevention of gastroduodenal toxicity", section on 'Proton pump inhibitors'.)

Retrospective analyses disagree on the value of low-dose aspirin in the management of GCA. In two cohorts, the odds ratios of so-called cranial ischemic events (sight loss and stroke) were reduced in GCA patients on antiplatelet therapy or anticoagulants, mainly the former, compared with patients on no such treatment [48,49]. In these studies, the majority of the aspirin-treated patients had been taking low-dose aspirin for the management of preexisting cardiovascular or cerebrovascular disease prior to the diagnosis of GCA and initiation of glucocorticoid therapy. Three other studies found no effect of established platelet inhibition on the occurrence of visual loss or stroke in newly diagnosed GCA [49-51]. None of the reports found an increased risk of gastrointestinal bleeding in the aspirin-treated patients.”

5mg is a low dose to be on, and if you haven’t had any flares your GCA seems well controlled. Plus as you haven’t seen your Rheumy in 18months, and your risk of strokes etc will have decreased since then, he may well have a different view of things ...in agreement with Prof Dasgupta and your GP ..... but really it’s your decision.

[garden49 in reply to DorsetLady]

Thank you for the information I am so grateful for the balanced picture.

[PMRpro Ambassador]

I suspect there is no evidence at all for that particular claim - there IS an increased risk of stroke in GCA in the first year after diagnosis but I think after that the risk falls again and the risk is more due to unmanaged inflammation than sticky platelets. As DL has said, it is now thought that the risk of GI bleeding, especially in combination with pred, far exceeds the benefits of the aspirin..

[garden49]

Many thanks that is so helpful.