Prevalence and characteristics of giant cell arteritis in patients with newly diagnosed polymyalgia rheumatica – a prospective cohort study

Abstract

Background: It is known that giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) often occur together. So far, the prevalence of GCA in newly diagnosed PMR patients has not been evaluated in a prospective ultrasound study. Objective: The aim of this study was to assess the prevalence of GCA using vascular ultrasound in patients with newly diagnosed PMR. Design: A consecutive cohort of newly diagnosed PMR patients was prospectively evaluated for the presence of GCA with the use of systematic musculoskeletal and vascular ultrasound examination. Methods: Overall, 60 patients with newly diagnosed PMR were prospectively enrolled. Symptoms and laboratory findings were collected. All patients underwent ultrasound of shoulder and hip joints, and vascular ultrasound evaluating the facial, temporal, carotid, vertebral and axillary arteries. Patients were diagnosed with GCA if they had ultrasound imaging findings of GCA. Patients with PMR (PMR-group) and patients with PMR and GCA (PMR–GCA-group) were compared, and a C-reactive protein (CRP) cut-off value was evaluated. Results: GCA was diagnosed in 28 of 60 PMR patients (46%). The PMR-group consisted of 20 (62.5%) females with a mean age of 69 (±9.9) years, while the PMR–GCA-group consisted of 11 (39.3%) females with a mean age of 74 (±8.4) years. In 13 of 28 patients (46%) in the PMR–GCA-group, GCA was subclinical and only diagnosed by ultrasound. The PMR–GCA-group showed higher values of joint effusion and significantly higher CRP values. A CRP cut-off value of 26.5 mg/litre (reference range 0–5 mg/litre) yielded a sensitivity of 66% with a specificity of 73% for GCA. Conclusion: GCA was found in 46% of newly diagnosed PMR patients; 22% of the patients with PMR had asymptomatic GCA. Joint effusions were higher in the PMR–GCA-group, with significant results for the hip joint. A CRP cut-off value of ⩾26.5 mg/litre in PMR can help in the identification of subclinical GCA.

Polymyalgia rheumatica: crafting the future of a simple (but not easy!) clinical syndrome

“…Effective clinical stratification instruments for primary care are yet to be developed, and it is possible that certain manifestations, such as constitutional symptoms or markedly elevated inflammatory markers, may play a pivotal role in identifying PMR patients with subclinical vasculitis. This assumption is supported by the association of these parameters with large-vessel inflammation in GCA 14…”

Rheumatologische Patienten in der Notaufnahme – Notfälle und Management

“…Es besteht eine Krankheitsverwandtschaft zwischen der Riesenzellarteriitis und der Polymyalgia rheumatica, sodass bei älteren Patienten (>50 Jahre) mit bewegungseinschränkenden bilateralen muskulären Schulter-und Hüftgürtelschmerzen, Morgensteifigkeit und B-Symptomatik (als klinische Indizien für eine Polymyalgia rheumatica) immer auch an eine Riesenzellarteriitis (RZA-Prävalenz unter Patienten mit Polymyalgia rheumatica: 46% [14]) gedacht werden sollte. Die 3 bedeutendsten sonografischen Zeichen der Riesenzellarteriitis sind: ▪ Das "Halo"-Zeichen (im Gefäßquerschnitt darstellbare konzentrische echoarme Gefäßwandauftreibung, welche auch zu einer deutlichen Reduktion der Gefäßquerschnittsfläche führt, in der sich in der farbkodierten Duplexsonografie noch ein erhaltener Blutfluss nachweisen lässt), ▪ das positive Kompressionszeichen (unter Kompression der Arterie bleibt die Gefäßwand aufgrund der entzündlichen Gefäßwandverdickung weiterhin sichtbar), ▪ die pathologische Zunahme des Intima-Media-Komplexes, dessen Messwerte sich mit publizierten Referenzwerten vergleichen lassen [16].…”

Should all patients with polymyalgia rheumatica have a vascular ultrasound assessment?

“…A systematic review that included imaging with US, positron emission tomography (PET) and MRI concluded that more than a quarter of PMR may have subclinical GCA on imaging 9. Recent US studies have confirmed this finding and suggested that this is a different PMR clinical phenotype, resulting in a different treatment protocol 10 11. A prospective US study that followed patients with PMR for up to 2 years found that those with US-identified subclinical GCA in PMR were almost four times more likely to relapse compared with isolated PMR 12.…”

“…Vascular scanning techniques for GCA diagnosis have been optimised and standardised,18 along with the development and validation of a US scoring system by OMERACT for monitoring vascular activity in GCA 17. These advances have led to two robust studies, which were published in 2023 with a combined population of over 400 patients with PMR 10 11. Both studies prospectively examined consecutively enrolled patients with newly diagnosed PMR without any clinical symptoms of cranial GCA.…”