Roberta
Roberta has giant cell arteritis (GCA), a type of systemic vasculitis. She has been offered a biologic medication to help her come off steroids but worries about the possible side effects of medicines.
Since 2016, Roberta had been enjoying retirement. She says she could finally afford to do things like have holidays abroad, make house improvements, and buy a car. As well as looking after her husband – who lives with the long-term effects of an injury – she was sociable and active, making frequent visits to her extended family.
Then, in 2019, Roberta had persistent facial pain for around a month, to the extent that she cut short a holiday in July. Sinusitis was suspected, but there no was improvement with over-counter medication or antibiotics. At a second out-hours appointment, Roberta mentioned her scalp was so tender that she couldn’t bear to rest her head on her pillow. Suspecting that Roberta had a type of vasculitis called giant cell arteritis (GCA), the doctor sent her over to the accident and emergency (A&E) department.
At A&E, blood tests and a CT scan showed very high inflammation but clear sinuses. As A&E also suspected that Roberta had GCA, she was given high dose steroids (prednisolone), a steroid treatment plan, and appointments for rheumatology and ophthalmology (eyes). Although her pain immediately improved with steroids, over the following months Roberta saw a number of different specialists, as there was some uncertainty about the cause of her symptoms.
It was initially thought that Roberta had trigeminal neuralgia, a condition which causes severe facial pain. Her steroids were reduced quickly and – when a temporal artery biopsy a few months later came back normal – she was started on treatment for trigeminal neuralgia. However, Roberta subsequently felt really ill and was in a lot of pain.
In December 2019, as her pain continued to worsen, Roberta went twice within a week to A&E. On the first occasion, she was upset to be sent home with no investigations or treatment. On the second, blood tests again showed inflammation. As a result, she was re-started on high dose steroids and booked for a second biopsy, which this time confirmed GCA.
Roberta says her rheumatologist is very thorough and has continued to arrange many scans, including a dental x-ray, to get to the bottom of her ongoing pain. However, given the fear and pain she experienced while the diagnosis was in doubt, she finds it difficult to trust doctors as much as she would like. In addition, she historically had bad side effects from medication, which makes her wary of taking more horribl drugs. In spite of this, she is considering her consultant’s recommendation to start tocilizumab (a biologic medication) to help her come off the steroids.
Roberta recently attended a support group and appreciates how they understand GCA in a way that family and friends cannot. She remembers speaking to her hairdresser about her tender scalp and would like to raise awareness of this as a symptom of GCA so that people can be diagnosed more quickly.