Incidence of cardiovascular events in polymyalgia rheumatica and giant cell arteritis amongst an Asian population: Propensity score matched cohort study

Kobayashi, Daiki; Suyama, Yasuhiro; Osugi, Yasuhiro; Arioka, Hiroko; Takahashi, Osamu; Kuriyama, Nagato

doi:10.1111/1756-185x.13328

Cited by 5 publications

(4 citation statements)

References 35 publications

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“…In PMR, data on the risk of coronary artery 171 and peripheral vascular 172 disease seem to be controversial: although some studies reported an increased risk in patients with PMR, others found the risk to be comparable with that of the general population 173,174 . Patients with PMR should therefore receive cardiovascular management on the basis of their individual risk profile.…”

Section: Disease and Treatment Complicationsmentioning

confidence: 99%

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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Giant cell arteritis (GCA) is the most common type of primary vasculitis in Western countries 1,2. Polymyalgia rheumatica (PMR) is the second most common inflammatory rheumatic disease of the elderly after rheumatoid arthritis (RA) 3. The two diseases are interrelated: 40-60% of patients with GCA have symptoms of PMR 3 , and histological features consistent with GCA have been found in 16-21% of temporal artery biopsy samples from patients with PMR 3. Most of these patients with PMR, however, presented with additional features of GCA, whereas the prevalence of positive histology in unselected patients with PMR is unknown. Both GCA and PMR are heterogeneous diseases. Although systemic manifestations (such as fever, malaise and weight loss) are common in both diseases, they are not present in all patients 4-6. Up to 1 in 5 patients with GCA with ocular involvement can present without systemic manifestations of the disease 7. GCA is the most common form of large-vessel vasculitis (LVV) and has a broad spectrum of disease manifestations, which are frequently overlapping. In the majority of cases, cranial and extracranial large arteries are involved to varying degrees, leading to different clinical phenotypes 8,9. Isolated cranial or extracranial GCA, which are at either end of this continuum, are relatively uncommon 10. Predominant cranial GCA is characterized by headache, jaw claudication and visual manifestations (representing the prototypical clinical picture of temporal arteritis). By contrast, predominant large-vessel GCA is characterized by more pronounced systemic manifestations, PMR, vascular bruits, limb claudication and imaging signs of inflammation in the aorta and its major branches 10. In some of these patients, vascular stenoses or aneurysms in association with other GCA features are the presenting clinical manifestations 9,11. PMR is characterized by pain and stiffness in the shoulder and pelvic girdles, which can have an abrupt or a subtle onset 3. Up to 20% of patients with PMR can present with a normal erythrocyte sedimentation rate (ESR) 12 , although the presence of both normal ESR and C-reactive protein (CRP) levels is rare 13-15. Glucocorticoids are the cornerstone of treatment for GCA and PMR. They are effective, but glucocorticoidrelated adverse effects occur in up to 85% of patients with GCA and 65% of patients with PMR, respectively 16-22. The IL-6 receptor inhibitor tocilizumab has become available as a glucocorticoid-sparing strategy in patients with GCA 23,24 , an approach that is also being evaluated for PMR 25,26. Management of both GCA and PMR is hampered by the lack of universally accepted definitions of remission and other disease states (such as low disease activity or vessel damage without active disease). Many questions about monitoring and long-term management are still unanswered (Box 1).

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Section: Disease and Treatment Complicationsmentioning

confidence: 99%

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

et al. 2020

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“…Furthermore, a meta-analysis of observational high-quality studies that included 34,569 patients with PMR showed a 72% excess risk of coronary artery disease among patients with PMR compared with subjects without PMR, even if the statistical heterogeneity of the reviewed studies was high 26 . Conversely, in a recent study, patients with PMR or GCA did not have a high risk for cardiovascular disease, but we must remark that the setting was Japan population, having the lowest incidence of PMR in the world and milder symptoms than in the Western countries 27 . The association of PMR with vascular disease may be explained by the elevated levels of C-reactive protein, which is also one of the independent biomarkers associated with cardiovascular disease 28 .…”

Section: Discussionmentioning

confidence: 63%

An exploratory cross-sectional study of subclinical vascular damage in patients with polymyalgia rheumatica

Silvestri

Ciciarello

Sessa

et al. 2020

Sci Rep

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the aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (pMR). We enrolled pMR patients having major cardiovascular risk factors (McVRf) and, as controls, patients with McVRf. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (iMt), the anterior-posterior abdominal aortic diameter (ApAD), and the prevalence of carotid artery stenosis; the cardio-ankle vascular index (cAVi) to measure arterial stiffness together with the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease. finally, we measured the serum levels of adipocytokines implicated in vascular dysfunction. As a result, 48 PMR and 56 MCVRF patients were included. An increase of IMT (1.

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“…While GCA is a major comorbidity in patients with PMR, it is 20 times less common in Asian populations compared with Caucasian patients. 34,35 This study represents only the characteristics of Asian patients with PMR. In addition, we reviewed the clinical data retrospectively, so the data from some patients were missing.…”

Section: Discussionmentioning

confidence: 99%

“…29 Patients with migraine, a primary form of headache, had higher platelet counts and lower platelet membrane fluidity or activity compared with controls. 34,35 This study represents only the characteristics of Asian patients with PMR. 32,33 Whether a patient with PMR reaches remission or continues with This study had several limitations due to the research method and the study population.…”

Section: Clinical Characteristics Including the Levels Of Nlr Plrmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio are associated with disease activity in polymyalgia rheumatica

Jung

Lee

Suh

et al. 2019

Clinical Laboratory Analysis

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Background The neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and monocyte‐to‐lymphocyte ratio (MLR) are indicators of systemic inflammation and are useful as markers in systemic rheumatic diseases. In this study, we compared the NLR, PLR, and MLR among patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA), and explored possible associations with clinical features, disease activity, and prognosis in patients with PMR. Methods The study enrolled 94 patients with PMR and 242 patients with RA who were initially diagnosed at the rheumatology clinic of a university‐based tertiary hospital. Symptoms, physical examination, and medical histories were collected with the results of laboratory tests. Results Neutrophil‐to‐lymphocyte ratio (4.5 ± 3.3 vs 2.8 ± 1.8), PLR (222.7 ± 115.5 vs 159.7 ± 78.1), and MLR (0.4 ± 0.3 vs 0.3 ± 0.2) were higher in patients with PMR compared with patients with RA (all P < .001). NLR, PLR, and MLR were correlated with specific laboratory values, including CRP and albumin, in patients with PMR. After disease activity resolved, NLR (2.95 ± 2.32, P < .001), PLR (137.5 ± 82.3, P < .001), and MLR (0.26 ± 0.16, P < .001) decreased significantly. By comparing patients according to the disease course, swollen joint counts were higher in the chronic course group compared with the remission group (P = .03), while the NLR, PLR, and MLR were similar. Conclusions Neutrophil‐to‐lymphocyte ratio, platelet‐to‐lymphocyte ratio, and monocyte‐to‐lymphocyte ratio levels were associated with disease activity and specific clinical features, although they could not predict prognosis in patients with PMR.

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Incidence of cardiovascular events in polymyalgia rheumatica and giant cell arteritis amongst an Asian population: Propensity score matched cohort study

Abstract: Patients with PMR or GCA may not have a higher risk of future cardiovascular diseases among the Japanese population. The sensitivity analyses and sample size calculation supported the results.

Cited by 5 publications

References 35 publications

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

Monitoring and long-term management of giant cell arteritis and polymyalgia rheumatica

An exploratory cross-sectional study of subclinical vascular damage in patients with polymyalgia rheumatica

Neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio are associated with disease activity in polymyalgia rheumatica

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