GCA and Cough/Interstitial Lung Disease?

[Moaningxcat]

Does anyone with GCA have a dry, sometimes productive, cough? It feels like a bronchial irritation and I cough more when I speak. The cough comes and goes. I read that it is an uncommon symptom of GCA. TB has been ruled out. Chest x-rays show opacities in the base of my lungs. The cough occurs when my other symptoms (weakness in arms and legs, fatigue, jittery, headachy) are worse. Could this be interstitial lung disease? My GP nor my rheumatologist have suggested this, but from my reading, it’s a possibility.

I’m currently tapering prednisone for 40 mg. I have been on 35 mg for the past 2 weeks and am supposed to taper to 30 mg starting this week, but I have decided to stay at 35 for now.

Any thoughts, experiences, advise, are more than welcome! Thank you all!

[pata63]

I just read something about this the other day after my Rhumatologist put me on Trimethoprim + Sulfamethoxazole as a prophylactic for Pneumocystis Pneumonia. It seems to be best practice here in NZ while on more than 20mg Prednisone.

ncbi.nlm.nih.gov/pmc/articl...

sciencedirect.com/science/a...

[Moaningxcat in reply to pata63]

I’m taking atovaquone, which is a safeguard for microbial pneumonia. I will read the links you sent. Thank you for the information.

[AtopicGuy in reply to Moaningxcat]

Atovaquone is, indeed, an anti-fungal treatment against PJP (pneumocystis jirovecii pneumonia). Below is a link to a 2023 paper about the condition. As you can see, it is almost wholly about very severely immunocompromised patients with HIV/AIDS, organ transplants, ongoing cancer therapy, etc. Otherwise-healthy patients with PMR/GCA alone are not included, as the degree of immunosuppression involved is much lower.

ncbi.nlm.nih.gov/books/NBK4...

[AtopicGuy in reply to pata63]

ncbi.nlm.nih.gov/pmc/articl...

sciencedirect.com/science/a...

The Conclusion of your 2011 paper (first link above) says: "PCP [pneumocystis pneumonia] is rare among patients with GCA."

The Conclusion of your 2023 paper (second link above) says: "Patients with newly diagnosed GCA or PMR rarely develop PJP [pneumocystis jirovecii pneumonia]. Existing data does not support routine prescribing of PJP prophylaxis for either group of patients." This was because: "During 547 patient-years of follow-up time, no cases of PJP were identified among 1,168 cases of GCA; during 7,446 patient-years of follow up time, one case of PJP was identified out of 15,575 cases of PMR."

The fungal lung disease being talked about (PCP/PJP) mostly affects patients who already have severe immunosuppression before taking corticosteroids. They may have HIV/AIDS, be taking powerful drugs to prevent rejection of a transplanted organ, or be undergoing cancer treatment, for example. Merely taking "more than 20mg Prednisone" per day is not grounds for prophylactic anti-fungal treatment in the vast majority of patients, as made clear in this clarification:

jamanetwork.com/journals/ja...

[Edited to insert the references into the post.]

[Moaningxcat in reply to AtopicGuy]

Thank you. I don’t think I have pneumonia. I’m concerned as previous X-rays and ct scans have shown scarring on my lungs and opacities at the base. I don’t know if the cough is related to that. I will check my meds to see if side effects can be sinusitis or rhinitis.

I appreciate your thoughts and the information!

[Sophiestree]

I have had a cough since starting pred. Sometimes dry sometimes productive, but mine is due to to sinus issues which I now have with a vengeance. I'm assuming due to being more susceptible to infection as some days it is all consuming others not so much. I now sleep with a humidifier and a himalayan salt ball in it... seems to be helping the dryness .

Pata63's response is interesting though.

[AtopicGuy in reply to Sophiestree]

Have you checked whether "sinusitis" or "rhinitis" is a listed side effect of any of your medications?

[PMR2011]

I did not have the usual scalp, jaw symptoms with my GCA. For me it was hoarseness (particularly when tired) and a dry cough (worse at the end of day when I laid down). I knew I’d overdone when I’d get those symptoms. 5 years later (for GCA and 13 years for PMR) am off all meds and symptoms resolved. Less common but sited in some articles.

[Moaningxcat in reply to PMR2011]

Thank you for responding. It’s much appreciated.

[Moaningxcat in reply to PMR2011]

My cough is worse when I overdo as well. So happy to hear you are symptom free and med free! Gives me hope.

[PMRpro Ambassador]

Did you have the cough pre-pred? It can be a symptom of GCA - but pred can also cause a cough.

[Moaningxcat in reply to PMRpro]

Good question… I had the cough when I was in the hospital for GCA. I don’t remember having a cough prior to that. Previous CT scans and X-rays of my lungs show some scarring and opacities at the base of my lungs. My GP has said it’s pneumonia, but I’m not sure about that… just had another chest X-ray today so we’ll see what that shows. Also, if I do have a problem with my lungs, should I be on methotrexate…. I’ll follow-up with my GP and rheumatologist once the chest X-rays come back. Can GCA have an impact on my lungs?

Thank you so much for responding. I didn’t know prednisone can cause a cough. It seems there are always questions with pmr/gca. Ugh.

[PMRpro Ambassador in reply to Moaningxcat]

If I had an x-ray as you describe I would be very unhappy about MTX without a lot of assurances.

[Moaningxcat in reply to PMRpro]

Agreed! Will be asking about that, for sure. I appreciate your advice!