Treatment of Polymyalgia Rheumatica and Giant Cell Arteritis: Are We Any Further Forward?
- Raashid Luqmani, DM
- From Botnar Research Centre, University of Oxford, Oxford OX3 7LD, United Kingdom
Giant cell arteritis (GCA) and polymyalgia rheumatica are common overlapping inflammatory rheumatic diseases of unknown cause that share some clinical features and affect patients older than 50 years. The age-adjusted annual incidence of GCA is 188 to 220 cases per 1 million persons (1, 2) in the United States and the United Kingdom and 290 per 1 million persons in Norway (3). The annual incidence of polymyalgia rheumatica varies from 120 per 1 million persons in Italy (4) to 1120 per million in Norway (3) and is higher in women than men.
Giant cell arteritis is easier than polymyalgia rheumatica to diagnose: Patients typically present with new, unaccustomed headache (more like head pain) that is associated with an increased erythrocyte sedimentation rate or a high C-reactive protein level. Permanent visual loss, which affects up to 15% of patients with GCA (5), is the most feared complication of the disease and is one of the main reasons for treating GCA as a rheumatologic emergency. Less common features include tongue or jaw claudication, indicating ischemia of the head and neck structures due to inflammatory narrowing or occlusion of arteries. Pathologic findings consist of granulomatous transmural inflammation starting from the adventitial layers and moving inward to occlude the vessel (6). More than 50% of patients have vascular inflammation affecting the aorta, femoral, and subclavian arteries (7).
Polymyalgia rheumatica is characterized by aching and stiffness of the neck, shoulders, and pelvis. One third of patients have associated weight loss, fever, and depression. The onset may be insidious, and diagnosis may be delayed until the patient has been extensively evaluated for other causes, including Parkinson disease, hypothyroidism, or metastatic cancer.
Polymyalgia rheumatica and GCA respond to treatment with corticosteroids. However, no consensus exists on how rapidly the steroid dosage can be …
This 100-word excerpt has been provided in the absence of an abstract.
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