Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a danish county

Abstract

A Prospective Investigation, 1982-1985 PER BOESEN and S(bREN FREIESLEBEN SqRENSEN The annual incidence of giant cell arteritis (the term used in this study to encompass the syndromes of temporal arteritis and polymyalgia rheumatica, occurring either together or alone) was prospectively determined in a Danish county that had a population of approximately 200,000. In a single year, 46 new cases of giant cell arteritis were diagnosed, a number which corresponds to an incidence in the overall population of 21.5/105, and to an incidence of 76.6/105 for individuals age 50 years or older. These rates are higher than those previously reported in retrospective studies. The 3-year followup of all patients showed no onset of other diseases that would require a revision of the original diagnosis. There was no deviation from the age-and sex-specific malignancy rate or the mortality rate in the overall population. Women had an incidence rate 4 to 5 times higher than that seen in men. Symptoms, for the most part, were the same as those found in other studies; however, vision loss was not observed during the followup period. Point prevalence at the start of the study was 37.8/105, which is below the rates previously reported. This is probably because of failure on the part of participating physicians to record all cases."Pure" temporal arteritis is characterized by symptoms such as headache, scalp tenderness, visual disturbances, and jaw claudication. On physical examination, the temporal artery may be normal or abnor-

Epidemiology of giant cell arteritis and polymyalgia rheumatica

“…Over the last 25-30 years, GCA has been found to be the most common type of vasculitis in Europe and North America, especially in people age Ͼ70 years (1,24,25). GCA mainly affects white individuals (2,25,26), and it almost exclusively occurs in subjects age Ͼ50 years (25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The incidence increases with age (32)(33)(34)(35)(36) and peaks in the 70 -79 years age group (28,32).…”

“…GCA mainly affects white individuals (2,25,26), and it almost exclusively occurs in subjects age Ͼ50 years (25,(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The incidence increases with age (32)(33)(34)(35)(36) and peaks in the 70 -79 years age group (28,32). In this regard, in Northwestern Spain, the incidence of GCA increased dramatically up to age 80 years and then decreased slowly (32,37).…”

“…GCA is also more common in women than in men (1). In Northern European countries, a 3:1 ratio of women to men was observed (33)(34)(35). A lower ratio of women to men was observed in Israel and Southern Europe (36,37).…”

Pathogenesis of giant cell arteritis

“…Other than anecdotal cases (16,23), there has been little clinical evidence of a relationship between GCA and the degree of sun exposure. Reported incidence rates of GCA in Europe and the United States have shown an opposite relationship: higher rates in northern latitudes, where the intensity of sun exposure tends to be less (24)(25)(26)(27), and lower in southern latitudes (28)(29)(30). Also, GCA has been noted to be common in the Pacific Northwest, which generally averages little sunlight (31).…”

“…The increasing frequency in persons over the age of 50 and the higher frequency in women have been well documented, but few hypotheses have been generated to explain these features (24)(25)(26)(27)(28)(29)(30). Hereditary or genetic factors are suggested by reports of GCA in multiple family members and by the results of population surveys showing the highest incidence rates in Northern Europe or in areas of the United States that have a similar ethnic composition (24-30,35).…”