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Giant-Cell Arteritis and Polymyalgia Rheumatica
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What is the problem and what is known about it so far?
Giant-cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two seemingly related inflammatory disorders. About 50% of people with GCA also have PMR; about 10% of people with PMR also have GCA. The causes of these disorders are unknown. They occur most often in people older than 50 years of age and increasingly often with advancing age. Both disorders are seen more often in women and in white persons. In GCA, also known as temporal arteritis or granulomatous arteritis, certain arteries, particularly those in the head, neck, and arms, become inflamed and swollen. The inflammation causes narrowed arteries and may result in complete blockage. Symptoms of GCA include headaches, scalp tenderness, and jaw pain while chewing. Less common symptoms include visual loss, sore throat, dry cough, and pain in the arms and legs. In PMR, inflammation occurs throughout the body. Symptoms include weight loss; fever; muscle pain; and neck, shoulder, and hip stiffness. Both disorders respond well to corticosteroids, such as prednisone. Many patients remain free of disease when corticosteroid therapy is stopped after several years.
Why did the authors do this review?
GCA and PMR can be hard to diagnose and treat. The authors wanted to describe improved diagnostic procedures and treatment strategies tailored to individual patient needs.
How did the authors do this review?
They analyzed research published in scientific journals on GCA and PMR.
What did the authors find?
Distinct forms of GCA and PMR affect specific arteries. Biopsy is the best method for evaluating GCA in the arteries of the head; for other forms of the disorder, imaging tests, such as magnetic resonance imaging and computed tomography, are useful. No specific diagnostic test is available for PMR. Corticosteroids seem to be the best treatment for GCA and PMR. Other drugs, such as methotrexate, that are often used to treat other inflammatory diseases have no proven or only questionable benefit. The best corticosteroid dose varies from patient to patient. Higher doses are risky but may speed healing of the arteries or prevent blindness due to reduced blood flow to the eye. Because corticosteroids cause many adverse effects, such as bone loss, weight gain, muscle weakness, and moodiness, physicians try to reduce the dose to the lowest level that controls the inflammation of the arteries. They rely on patients' symptoms because they don't have effective blood tests to guide them. Once corticosteroid treatment is started, GCA and PMR symptoms usually disappear quickly. Patients may develop aortic aneurysm, in which part of the major artery from the heart becomes weakened and bulges abnormally. The frequency of this complication is unclear. Once corticosteroid therapy is stopped after a period of little or no symptoms, inflammation typically continues at a low level. However, clinical symptoms of GCA or PMR relapse only infrequently.
What are the implications of this review?
It is important to be able to accurately differentiate between GCA and PMR because specific treatment of each disease can lead to greatly improved outcomes.
Article and Author Information
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The full report is entitled “Giant-Cell Arteritis and Polymyalgia Rheumatica.” It is in the 16 September 2003 issue of Annals of Internal Medicine (volume 139, pages 505-515). The authors are C.M. Weyand and J.J. Goronzy.
- Copyright ©2004 by the American College of Physicians
