Background Polymyalgia rheumatica (PMR) may be complicated by inflammation of the temporal artery in about 10-20% of the patients; inversely, about 40-50% of people with temporal arteritis (TA) also have PMR (1). TA may involve blood vessels of different size and may be associated with coexistent inflammation of the accompanying veins.
Objectives The aim of this study was to determine the prevalence and relationship of TA and temporal phlebitis (TP) in PMR.
Methods Surgical biopsy specimens of the temporal artery of 299 patients with clinically diagnosed PMR were studied. PMR was clinically diagnosed according to the criteria of Bird et al (2). TA and TP were histologically diagnosed. The link between TA and TP was determined by c²-test.
Results TA in different stages of inflammation was present in 71 (23.74%) of 299 patients (females 61, average age 71.8 years, range 88-43; males 10, average age 71.9 years, range 86-51). Histologically segmental or sectorial TA involved dominantly the medium size arteries (characterized by presence of internal and external elastic membrane). TA of medium size vessels was occasionally accompanied by concomitant vasculitis of small arteries (characterized by presence of internal elastic membrane only) and/or arterioles (characterized by absence of internal and external elastic membrane). In some cases TA existed only in small arteries or arterioles without involvement of medium size arteries. Temporal arteritis may be accompanied with concomittant phlebitis.
TA of medium size arteries was present in 52, TA of small arteries in 18, and TA of arterioles in 42 of 299 patients, separately or in combination. TA of medium size arteries coexisted simultaneously with TA of small arteries in 11, and with TA of arterioles in 33 of 299 patients. There was a strong positive and significant correlation between TA of medium size and small arteries (c²=25.48, p<0.0001) or arterioles (c²=127.31, p<0.0001). The relationship between TA of small arteries and of arterioles was also significant (c²=53.69, p<0.0001). Inflammation of temporal veins was present simultaneously with TA in 10 of 299 patients. There was a strong positive and significant correlation between TA and TP (c²=24.52, p<0.0001).
Conclusions TA like any type of autoimmune vasculitis is a systemic disorder, with a predilection to involve the extracranial (superficial temporal and occipital), and intracranial branches of the carotid arteries (ie, the ophthalmic, and posterior ciliary arteries), but other vessels may be involved as well, like the vertebral arteries, the subclavian arteries, the aortic wall, and rarely, the femoral or coronary arteries (3).
Dominant involvement of medium size ateries may be accompanied with vasculitis of smaller vessels, even veins. The close statistical relationships between inflammations in arteries of different size and veins support the impression that all of these cohere and are manifestations of the same disease. The significantly positive link between arteries and veins support the systemic nature (idiosyncrasy, characteristics, and trait) of TA.
Giant Cell Arteritis - Associated Conditions: in Harrison’s Practice. McGraw-Hill Companies, Inc. 2012
Bird HA, Esselinckx W, Dixon AS, Mowat AG: An evaluation of criteria for polymyalgia rheumatica. Ann Rheum Dis 1979;38:434-439
Flood TA, Burke AP: Temporal Arteritis Pathology http://emedicine.medscape.com/article/1612591
Disclosure of Interest: None Declared