Polymyalgia Rheumatica

Oa, Kogstad

doi:10.1111/j.0954-6820.1965.tb04307.x

Cited by 48 publications

(2 citation statements)

References 13 publications

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“…It has been estimated that up to 20% of PMR patients may have abnormal histology compatible with GCA on temporal artery biopsy or large vessel inflammation depicted by magnetic resonance imaging or positron emission tomography (PET) scan. [5][6][7] In the third group, peripheral vascular involvement with large vessel vasculitis (LVV) may dominate the clinical picture causing a variety of symptoms ranging from back and neck pain, to arm claudication, to hand paresthesia, to atypical Raynaud syndrome-like symptoms. This form of GCA is frequently seen in those patients in whom the inflammatory process primarily affects the ascending aorta, aortic arch, and/or its major branches and thus may mimic Takayasu arteritis.…”

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confidence: 99%

“…In the second group, GCA patients present with otherwise typical symptoms of PMR with or without tenderness of temporal artery on examination. It has been estimated that up to 20% of PMR patients may have abnormal histology compatible with GCA on temporal artery biopsy or large vessel inflammation depicted by magnetic resonance imaging or positron emission tomography (PET) scan 5–7 …”

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confidence: 99%

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Atypical Large Vessel Vasculitis Presenting With Cholestatic Liver Abnormalities

Sangha¹,

Lenert²,

Dawoud³

et al. 2021

J Clin Rheumatol

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Clinicians usually easily recognize cranial manifestations of giant cell arteritis (GCA) such as new-onset headache, jaw claudication, scalp tenderness, and abrupt changes in visual acuity or blindness; however, when presented with an aberrant clinical course, the diagnosis becomes more elusive. In addition to temporal arteries and other extracranial branches of the carotid arteries, large vessel vasculitis (LVV) can also affect other blood vessels including coronary arteries, aorta with its major branches, intracranial blood vessels, and hepatic arteries.Over time, the scope of the symptoms typically associated with LVV has broadened and includes cases of fever of unknown origin accompanied with other constitutional symptoms that can mimic a range of neoplastic and infectious diseases. In up to half of patients with atypical LVV, liver enzyme level elevations with a cholestatic pattern have been observed. Alkaline phosphatase level and γ-glutamyl transferase level elevations tend to be more prevalent in those LVV patients with vigorous inflammatory responses, particularly in those with fever and other nonspecific constitutional symptoms. These patients also have more profound anemia and thrombocytosis. With the exception of rare instances of vasculitides and granulomas affecting the liver tissue, liver biopsy is generally of little help and primarily shows nonspecific changes of fatty liver.In this article, we review 3 patients who were eventually diagnosed with atypical LVV. The diagnosis was confirmed with temporal artery biopsy in 2 patients and with positron emission tomography/computed tomography in 1 patient. The common hepatic abnormality observed in all patients was the elevation of alkaline phosphatase level, which tended to respond rapidly to initiation of immunosuppressive treatment.

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confidence: 99%