The management of polymyalgia rheumatica and giant cell arteritis

1993 ◽  
Vol 31 (17) ◽  
pp. 65-68
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Features ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Systemic Corticosteroid ◽  
Vascular Complications ◽  
Pure Form ◽  
Patient Treatment ◽  
Precise Relationship

Polymyalgia rheumatica and giant cell (cranial/temporal) arteritis are common debilitating conditions affecting people nearly always over the age of 55. Although the two syndromes are closely linked their precise relationship is not fully understood. Polymyalgia rheumatica or giant cell arteritis can occur in a ‘pure’ form or clinical features of each may be present in the same patient. Treatment with a systemic corticosteroid has long been considered mandatory in patients with giant cell arteritis in order to prevent serious vascular complications, particularly blindness1. Treatment with corticosteroid is also usual for patients with polymyalgia rheumatica. Many patients remain on steroids for years. What is the basis for current approaches to management? How should steroids be given and eventually stopped?

Polymyalgia Rheumatica - a Disease of the Elderly

2018 ◽  
Vol 69 (1) ◽  
pp. 152-154
Author(s):  
Vasilica Cristescu ◽  
Aurelia Romila ◽  
Luana Andreea Macovei
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Viral Infections ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Clinical Aspects ◽  
Immune Disorder ◽  
Markers Of Inflammation

Polymyalgia rheumatica is a disease that occurs mostly in the elderly and is rarely seen in patients less than 50 years of age. Polymyalgia rheumatica is a vasculitis, which manifests itself as an inflammatory disease of the vascular wall that can affect any type of blood vessel, regardless of its size. It has been considered a form of giant cell arteritis, involving primarily large and medium arteries and to a lesser extent the arterioles. Clinical manifestations are caused by the generic pathogenic process and depend on the characteristics of the damaged organ. PMR is a senescence-related immune disorder. It has been defined as a stand-alone condition and a syndrome referred to as rheumatic polyarteritis with manifestations of giant cell arteritis (especially in cases of Horton�s disease and temporal arteritis) which are commonly associated with polymyalgia. The clinical presentation is clearly dominated by the painful girdle syndrome, with a feeling of general discomfort. Polymyalgia and temporal arteritis may coexist or be consecutive to each other in the same patient, as in most of our patients. The present study describes 3 cases of polymyalgia rheumatica, admitted to the Clinic of Rheumatology of Sf. Apostol Andrei Hospital, Galati. The cases were compared with the literature. Two clinical aspects (polymyalgia rheumatica and/or Horton�s disease) and the relationship between them were also considered. Polymyalgia rheumatica is currently thought to have a multifactorial etiology, in which the following factors play a role: genetic factors or hereditary predisposition (some individuals are more prone to this disease), immune factors and viral infections (triggers of the disease). Other risk factors of polymyalgia rheumatica include age over 50 years and the association with giant cell arteritis. The characteristic feature of the disease is girdle pain, with intense stiffness of at least one hour�s duration. Markers of inflammation, erythrocyte sedimentation rate and C-reactive protein are almost always increased at the onset of the disease. Diseases that can mimic the clinical picture of polymyalgia rheumatica are neoplasia, infections, metabolic disorders of the bone and endocrine diseases.

Polymyalgia rheumatica and temporal arteritis

2010 ◽  
pp. 3678-3683
Author(s):  
Jan Tore Gran
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Histological Examination ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Superficial Temporal Artery ◽  
Granulomatous Inflammation ◽  
Temporal Artery ◽  
Unknown Aetiology ◽  
Inflammatory Conditions

Polymyalgia rheumatica and temporal arteritis are distinct but overlapping inflammatory conditions of unknown aetiology. They almost exclusively affect people over 50 years of age, women more than men (ratio 2–3:1), and particularly those of Nordic heritage. Temporal arteritis is characterized by granulomatous inflammation that penetrates all layers of the wall of medium and (often) large muscular arteries, in particular the superficial temporal artery. Histological examination of tissues from patients with polymyalgia rheumatica shows nonspecific changes only. The term ‘giant cell arteritis’ is properly used only to describe patients with biopsy-proven arteritis....

–463 G/A myeloperoxidase promoter polymorphism in giant cell arteritis

2007 ◽  
Vol 67 (4) ◽  
pp. 485-488 ◽  
Author(s):  
C Salvarani ◽  
B Casali ◽  
E Farnetti ◽  
N Pipitone ◽  
D Nicoli ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Features ◽  
Polymyalgia Rheumatica ◽  
Visual Loss ◽  
Geographic Area ◽  
Population Based ◽  
Promoter Polymorphism ◽  
Reggio Emilia ◽  
Cerebrovascular Accidents

Objective:To investigate potential associations between–463 G/A myeloperoxidase (MPO) promoter polymorphism and susceptibility to, and clinical features of giant cell arteritis (GCA).Methods:A total of 156 patients with biopsy-proven GCA who were residents of Reggio Emilia, Italy, and 235 population-based controls from the same geographic area were genotyped for–463 G/A promoter polymorphism of the MPO gene by molecular methods. The patients were subgrouped according to the presence or absence of polymyalgia rheumatica and severe ischaemic complications (visual loss and/or cerebrovascular accidents).Results:The distribution of the MPO-G/A genotype differed significantly between patients with GCA and the controls (pcorr = 0.003). Allele G was significantly more frequent in patients with GCA than in the controls (pcorr = 0.0002, OR 2.0, 95% CI 1.4 to 2.9). Homozygosity for the G allele was significantly more frequent in patients with GCA than in controls (pcorr = 0.0002, OR 2.2, 95% CI 1.4 to 3.4). No significant associations were found when patients with GCA with and without polymyalgia rheumatica or with and without severe ischaemic complications were compared.Conclusions:Our findings show that the–463 G/A promoter polymorphism of the MPO gene is associated with GCA susceptibility and support a role for MPO in the pathophysiology of GCA.

Bilateral juvenile temporal arteritis mimicking clinical features of classic giant cell arteritis

2020 ◽  
Vol 59 (11) ◽  
Author(s):  
Hind Al‐Busani ◽  
Takeshi Namiki ◽  
Shown Tokoro ◽  
Tsukasa Ugajin ◽  
Keiko Miura ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Clinical Features ◽  
Temporal Arteritis

Polymyalgia Rheumatica, Giant Cell Arteritis, and Vascular Complications

2017 ◽  
pp. 23-38
Author(s):  
Viera Štvrtinová ◽  
Denisa Čelovská ◽  
Svetoslav Štvrtina ◽  
Jozef Rovenský
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Vascular Complications

scholarly journals Clinical presentation and treatment response in patients with polymyalgia rheumatica and giant cell arteritis during a 40-week follow-up

2021 ◽  
Author(s):  
Amir Emamifar ◽  
Søren Hess ◽  
Torkell Ellingsen ◽  
Oke Gerke ◽  
Ziba Ahangarani Farahani ◽  
...  
Keyword(s):  
Giant Cell Arteritis ◽  
Treatment Response ◽  
Giant Cell ◽  
Clinical Features ◽  
Polymyalgia Rheumatica ◽  
Fdg Pet ◽  
Temporal Artery Biopsy ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Objectives To study the clinical features of polymyalgia rheumatica and/or giant cell arteritis (PMR/GCA) and clinical predictors of treatment response during a 40-week follow-up period. Method Clinical data on 77 patients with newly diagnosed PMR/GCA who were treated by oral glucocorticoids were gathered at baseline and during 40-week follow-up period. A unilateral temporal artery biopsy (TAB) and 18 F-FDG PET/CT were undertaken at diagnosis. In total, each patient was seen at 5 occasions i.e. baseline, weeks 4, 16, 28, and 40. Treatment response was assessed considering clinical evaluations and results of inflammatory markers. Results Of 77 patients (49(63.6%) female, mean age : 71.8 ± 8.0), 64(83.1%) patients had pure PMR, 10(13.0%) concomitant PMR and GCA, and 3(3.9%) pure GCA. The patients reported clinical symptoms except scalp pain and duration of morning stiffness improved significantly at week 4 and remained lower at week 40 compared with the relative frequencies at baseline. Besides, all components of physical examination showed significant improvement and remained lower at week 40 compared with the baseline. 68.7%, 62.9%, 44.1% and 33.3% of the patients had a complete response at weeks 4, 16, 28, and 40, respectively. Several clinical features including female gender, younger age, fewer relapse, and lower level of baseline ESR were significantly associated with a better treatment response. Treatment response during follow-up period was independent of TAB results and FDG uptakes on 18 F-FDG PET/CT at diagnosis. Conclusion Obtaining valid disease specific outcome measures for evaluating treatment efficacy in PMR and GCA, that can be applied universally is clearly an unmet clinical need. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov, NCT02985424

Polymyalgica rheumatica and giant cell arteritis

2008 ◽  
Vol 18 (2) ◽  
pp. 91-101 ◽  
Author(s):  
H A Bird ◽  
Helen Mac Iver
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Visual Loss ◽  
Temporal Arteritis ◽  
Morning Stiffness ◽  
Temporal Artery ◽  
Shoulder Girdle ◽  
Pelvic Girdle ◽  
Disease Spectrum

Polymyalgia rheumatica and giant cell arteritis are closely related conditions, considered by many to represent opposite poles of a single disease spectrum. They can occur together or separately.Polymyalgia rheumatica is characterized by pain and morning stiffness in the shoulder girdle and sometimes the pelvic girdle. The symptoms are felt to be related to synovitis of proximal joints and extra-articular synovial structures. Giant cell arteritis displays a frank vasculitis affecting the regions supplied by the temporal artery to give visual loss and scalp tenderness but is increasingly recognized to also affect the aorta and its extra-cranial branches. For this reason the term ‘giant cell arteritis’, which is descriptive of the pathology, is used instead of the alternative term ‘temporal arteritis’, which gives a misleading impression of localization but which was the term used in previous reviews for this journal, the most recent in 2003.

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