Prevalence of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica

Narváez, Javier; Estrada, Paula; López-Vives, Laura; Ricse, M.; Zacarías, Andrea; Heredia, S.; Gómez-Vaquero, Carmen; Nolla, Joan M.

doi:10.1016/j.semarthrit.2015.06.009

Cited by 59 publications

(27 citation statements)

References 45 publications

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“…More likely, it seems that both are a result of an unknown causative factor (or factors), sometimes expressed as PMR, sometimes as GCA, and sometimes as a combination of both conditions. There is a wide range of the reported frequency of PMR in GCA patients (17%–66%), and it is estimated that 10% of “isolated” PMR cases develop GCA symptoms 5. Clinically, the two conditions may present together but may sometimes be separated by long intervals, and either one may present first.…”

Section: Epidemiologymentioning

confidence: 99%

Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update

Nesher

Breuer

2016

Rambam Maimonides Med J

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Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are both more common among people of North European decent than among Mediterranean people. Women are 2–3 times more commonly affected. Giant cell arteritis and PMR are extremely rare before age 50 years. Polymyalgia rheumatica may be “isolated” or associated with GCA. There is increased expression of inflammatory cytokines in temporal arteries of PMR patients, without overt histological evidence of arteritis. One-third of “isolated” PMR patients have vascular uptake in positron emission tomography (PET) scans, suggesting clinically unrecognized, “hidden” GCA. Typical manifestations of GCA are headache, tenderness over temporal arteries, jaw claudication, PMR, acute vision loss, and low-grade fever. Bilateral aching of the shoulders with morning stiffness is typical for PMR. In both conditions sedimentation rate and C-reactive protein are elevated, and anemia and thrombocytosis may occur. Color duplex ultrasonography of the temporal arteries may aid in GCA diagnosis. Temporal artery biopsy showing vasculitis, often with giant cells, confirms GCA diagnosis. In cases with negative biopsy one must rely on the clinical presentation and laboratory abnormalities. The diagnosis of PMR is made primarily on clinical grounds. Other conditions that may mimic GCA or PMR must be excluded. Glucocorticoids are the treatment of choice for both conditions. Prompt treatment is crucial in GCA, to prevent irreversible complications of acute vision loss and stroke. Addition of low-dose aspirin may further prevent these complications. The average duration of treatment is 2–3 years, but some patients require a prolonged course of treatment, and some may develop disease-related or treatment-related complications. No steroid-sparing agent has been proven to be widely effective thus far, but some promising therapeutic agents are currently being studied.

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Section: Epidemiologymentioning

confidence: 99%

Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update

Nesher

Breuer

2016

Rambam Maimonides Med J

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“…Although PMR and GCA exhibit a rapid response to corticosteroids in most cases, the initial dose required for the management of these conditions is certainly different. Thus, whereas 12.5-25 mg/day of prednisone/prednisolone is the initial dose of glucocorticoid recommended by the EULAR expert Committee for the management of PMR [11], this dose is in most cases insufficient to prevent severe ischemic manifestations in patients with GCA [12,13]. Moreover, in some cases, patients initially diagnosed as having isolated PMR experience a relapse that include features of a previously silent GCA [13].…”

mentioning

confidence: 99%

Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica

Prieto-Peña

Martínez-Rodríguez

Loricera

et al. 2019

Seminars in Arthritis and Rheumatism

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“…Besides, medium-sized arteries such as cranial arteries, arteries supplying the eyes (ophthalmic artery, posterior ciliary arteries, central retinal artery), ears, and even some small vessels are commonly affected [1,2,4,9,13,17]. The advances in techniques of PET/CT, CT, and MRI have contributed to better identification and evaluation of vascular involvement in the vasculitis patients [28]. In this study, involvement of arteries under aortic arch was higher in GCA patients without PMR.…”

Section: Discussionmentioning

confidence: 62%

Differences in clinical manifestations and prognosis of Chinese giant cell arteritis patients with or without polymyalgia rheumatica

et al. 2018

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Background The symptoms of giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) frequently overlap in the elderly. Whether there are differences in clinical features or prognosis between GCA patients with or without PMR remains unknown. Aims To identify differences in clinical manifestation and prognosis between Chinese GCA patients with or without PMR. Methods A retrospective study of patients diagnosed with GCA in Peking Union Medical College Hospital (PUMCH) during the last 20 years was conducted. Clinical data was collected and analyzed accordingly, and follow-up was performed. Results A total of 50 patients had PMR, while 41 patients did not, with no significant differences in age, gender, and disease course between the two groups. GCA patients with PMR presented with higher risks of family history of malignancy (p = 0.048). Patients without PMR had higher proportion of hearing loss (p = 0.006), ANCA positive (p = 0.024), and abnormal imaging findings illustrating the involvement of arteries under aortic arch (p = 0.018). Before treatment, total lymphocyte counts in patients without PMR were lower than those with PMR, and monocyte counts in both groups were higher than normal. Acute phase reactants in patients without PMR were higher than the other group. No significant differences were found in prognosis during follow-up. Conclusions GCA patients with or without PMR have different clinical characteristics. Patients with PMR present myalgia or arthralgia more frequently, while those without PMR have higher inflammatory markers, lower lymphocyte counts, and wider involvement of arteries under aortic arch.

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Prevalence of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica

Cited by 59 publications

References 45 publications

Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update

Giant Cell Arteritis and Polymyalgia Rheumatica: 2016 Update

Predictors of positive 18F-FDG PET/CT-scan for large vessel vasculitis in patients with persistent polymyalgia rheumatica

Differences in clinical manifestations and prognosis of Chinese giant cell arteritis patients with or without polymyalgia rheumatica

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