Highlights in clinical medicine—Giant cell arteritis, polymyalgia rheumatica and Takayasu’s arteritis: pathogenic links and therapeutic implications
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The annual incidence of giant cell arteritis (the term used in this study to encompass the syndromes of temporal arteritis and polymyalgia rheumatica, occurring either together or alone) was prospectively determined in a Danish county that had a population of approximately 200,000. In a single year, 46 new cases of giant cell arteritis were diagnosed, a number which corresponds to an incidence in the overall population of 21.5/10(5), and to an incidence of 76.6/10(5) for individuals age 50 years or older. These rates are higher than those previously reported in retrospective studies. The 3-year followup of all patients showed no onset of other diseases that would require a revision of the original diagnosis. There was no deviation from the age- and sex specific malignancy rate or the mortality rate in the overall population. Women had an incidence rate 4 to 5 times higher than that seen in men. Symptoms, for the most part, were the same as those found in other studies; however, vision loss was not observed during the followup period. Point prevalence at the start of the study was 37.8/10(5), which is below the rates previously reported. This is probably because of failure on the part of participating physicians to record all cases.
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Glucocorticoids are highly effective in treating polymyalgia rheumatica and giant cell arteritis, but their use is associated with numerous adverse events. Therefore, it is important to use them for the shortest period of time possible. The published evidence suggests that discontinuation of GC is feasible in a substantial number of patients with polymyalgia rheumatica and giant cell arteritis after an adequate period of treatment, provided that glucocorticoids are tapered gradually. Recurrences are relatively infrequent in polymyalgia rheumatica and somewhat more common in giant cell arteritis. Immunosuppressive agents may be used in patients with frequently relapsing or recurring disease to decrease exposure to glucocorticoids.
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The occurrence of giant cell arteritis (GCA) (considering temporal arteritis and polymyalgia rheumatica as its manifestations) was investigated in Western Nyland, Finland. Between 1984 and 1988 54 patients were diagnosed in a population of about 44,500. Fourteen patients (26%) had biopsy proven arteritis at the initial evaluation, and 2 patients became biopsy positive during followup. The retrospectively determined annual incidence of GCA in a 44 month period was 22.5/10(5) in the whole population, and 69.8/10(5) in residents aged 50 years or older. The corresponding figures of a prospective 16 month study were 30.4/10(5) and 94.4/10(5). The incidence rates of the prospective study are higher than those reported in comparable studies. Polymyalgia rheumatica, occurring alone or combined with cranial symptoms, was the most frequent manifestation of GCA, being present in 87% of patients.
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Both giant-cell arteritis and polymyalgia rheumatica are immune-mediated diseases that are treated with glucocorticoids, with higher doses used for giant-cell arteritis. Prompt initiation of high doses and a biopsy are recommended when ischemic optic neuropathy is suspected.
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Letters15 April 1995Cytokines in Polymyalgia and Giant Cell ArteritisLarry M. GreenbaumLarry M. GreenbaumSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-122-8-199504150-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Weyand and colleagues [1] found that patients with polymyalgia rheumatica and giant cell arteritis have similar cytokine profiles. However, their patients with polymyalgia rheumatica may not be representative of most of these patients. Seventeen tissue samples from 9 different patients were available for analysis. It is unclear whether 17 different temporal artery biopsy specimens were taken from 9 patients or whether different fragments of the same biopsy specimen were analyzed separately for some patients. In most patients with polymyalgia rheumatica, bilateral temporal artery biopsy specimens are not usually analyzed. I wonder whether this group of patients with ...REFERENCE1. Weyand CM, Hicok KC, Hunder GG, Goronzy JJ. Tissue cytokine patterns in patients with polymyalgia rheumatica and giant cell arteritis. Ann Intern Med. 1994; 121:484-91. Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 15 April 1995Volume 122, Issue 8Page: 634KeywordsArteriesBiopsyCytokinesGiant cellsPatient advocacyPolymyalgia rheumatica Issue Published: 15 April 1995 Copyright & PermissionsCopyright © 1995 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
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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 blindness 1 . 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?
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ABSTRACT Ninety patients with giant cell arteritis (GCA) were followed for 9–16 years after diagnosis. Corticosteroids were given to all but one patient. Forty‐two patients died during the observation period (27 women and 15 men). The survival was compared with that in the general population and found not to be reduced among the GCA patients. In fact, we found a lower mortality than expected after five years from diagnosis ( p <0.05). We did not see any increase in deaths due to vascular or malignant diseases in our patients.
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Polymyalgia rheumatica, next to rheumatoid arthritis the most common inflammatory rheumatic disorder of the elderly, is a nonspecific clinical syndrome involving pain in the shoulder and pelvic girdles. Giant cell arteritis appears to localize in elastin-containing arteries and can cause similar myalgias. A relationship exists between the two diseases, as evidenced by their frequent coexistence in the same patient. The symptoms of polymyalgia rheumatica respond to low-dose corticosteroid therapy, while giant cell arteritis requires higher doses to prevent blindness due to involvement of the temporal artery. The key decision in therapy, therefore, concerns the dose and duration of use of steroid for polymyalgic symptoms. In this decision, prevention of the catastrophic complications of giant cell arteritis and avoidance of needless side effects of high-dose steroid therapy in the elderly are competing considerations.
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