The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease

Abstract

GCA and PMR are conditions of older persons that frequently overlap. The traditional concept of GCA has focused on cranial symptoms such as headache and visual disturbance, but extra-cranial manifestations such as constitutional symptoms, polymyalgia and limb claudication have also long been recognized. These symptoms may coincide with cranial GCA, occur as an independent clinical subset [large-vessel (LV) GCA] or overlap with PMR. Imaging studies have demonstrated that up to one-third of patients with PMR have subclinical LV inflammation at disease outset. The implication of this finding for PMR management is unclear. Pathophysiological studies have emphasized the pivotal role of dendritic cells (DCs) and T cells in the pathogenesis of GCA, and the activation of certain pattern recognition receptors on DCs may determine the clinical subset of GCA. In patients with only PMR clinically, it is conceivable that transmural arterial inflammation has either not yet started or is prevented by unexplored regulatory pathways. This concept is supported by vasculitis of peri-adventitial small-vessels and activated DCs in the adventitia of temporal arteries, in the absence of media-infiltrating T cells. This review examines the clinical and pathophysiological spectrum of GCA and its subsets with PMR, the role of newer imaging techniques for GCA diagnosis and the management of these diseases.

Anarthritic Rheumatoid Arthritis and the Continuing Dilemma of Polymyalgia Rheumatica: Case Report

“…Instead, these researchers not only perpetuate traditional concepts of CSs treatment in PMR, but they also speculate on atypical temporal artery biopsy findings in PMR to explain why it not infrequently overlaps with classical biopsy proven GCA. It may well be verified that pure PMR (i.e., PMR that does not evolve into SNRA) is accompanied by limited subclinical large vessel inflammation that does not become transmural, thereby precluding the development of classical clinical and pathological GCA [6]. My patient did not manifest any temporal artery biopsy abnormalities, and she exemplifies the pitfalls of utilizing classical symptomatology for definitive diagnosis of both PMR and GCA.…”

“…It suggests that most patients with PMR evolve their disease process into SNRA, which in turn can be successfully treated without ever implementing CSs. And yet recent reviews by investigators studying PMR have chosen to ignore this evidence [4,5,6]. Instead, these researchers not only perpetuate traditional concepts of CSs treatment in PMR, but they also speculate on atypical temporal artery biopsy findings in PMR to explain why it not infrequently overlaps with classical biopsy proven GCA.…”

Pyrexia of Unknown Origin- An elusive diagnosis

“…The most typical manifestations of GCA include headache, temporal artery tenderness, jaw claudication, visual disturbances and Polymyalgia rheumatica. In a study by Gonzalez-Gay et al headache is seen in 87% of the patients with GCA, whereas, 100% cases of GCA presented with headache in a study conducted in south India [4,5].…”

“…Magnetic resonance angiogram of other arterial systems should be done as other large arteries can also be affected. The traditional concept of GCA focused on cranial symptoms of headache and visual loss is gradually changing and more attention is given to the constitutional symptoms [4].…”

Relationship Between Arthritis And Muscular Strength In Older Women With Symptoms Of Sarcopenia

“…GCA, which closely related to PMR, also occurs in the older population but causes vasculinitis in the cranial arteries causes symptoms such as including visual disturbances and headaches. GCA can also cause limb claudication as well as polymyalgia (Dejaco, Duftner, Buttgereit, Matteson, & Dasgupta, 2016;Gonzalez-Gay, 2004). Overall, arthritis is known to limit functionality and lead to disability Song et al, 2006).…”