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Aortic stiffness is increased in polymyalgia rheumatica and improves after steroid treatment
  1. Giuseppe Schillaci1,
  2. Elena Bartoloni2,
  3. Giacomo Pucci1,
  4. Matteo Pirro1,
  5. Laura Settimi1,
  6. Alessia Alunno2,
  7. Roberto Gerli2,
  8. Elmo Mannarino1
  1. 1Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Perugia, Italy
  2. 2Unit of Rheumatology, University of Perugia, Perugia, Italy
  1. Correspondence to Professor Giuseppe Schillaci, Medicina Interna, Angiologia e Malattie da Arteriosclerosi, Università degli Studi di Perugia, Ospedale “S. Maria della Misericordia” piazzale G. Menghini, 1-06129 Perugia, Italy; skill{at}unipg.it

Abstract

Background Inflammatory rheumatic diseases have been associated with increased cardiovascular risk and arterial stiffness. Polymyalgia rheumatica (PMR), a disease which affects primarily older people, is characterised by a systemic inflammatory response but little is known about aortic involvement in PMR. A study was undertaken to investigate whether aortic stiffness is increased in PMR and whether it improves after steroid treatment.

Methods Thirty-nine patients with PMR (age 72±8 years, 44% men, blood pressure (BP) 134/75±16/9 mm Hg) and 39 age-, sex- and BP-matched control subjects underwent aortic pulse wave velocity (PWV) determination. Aortic augmentation as a measure of the impact of the reflection wave on central haemodynamics was also measured and corrected for heart rate. Twenty-nine of the patients were re-examined after 4 weeks of treatment with prednisone at a dose of 15 mg/day.

Results Aortic PWV was higher in patients with PMR than in control subjects (12.4±4 vs 10.2±2 m/s, p<0.01). Treatment was followed by a reduction in heart rate (from 78±12 to 70±10 beats/min, p<0.001) and no significant change in BP. Aortic PWV decreased after prednisone treatment (from 11.8±3 to 10.5±3 m/s, p=0.015), and the difference was independent of BP and heart rate changes. The change in aortic PWV had a direct correlation with percentage change in plasma C reactive protein (r=0.40, p=0.037). Treatment was also associated with a significant reduction in aortic augmentation index (from 34±7% to 29±8%, p=0.012).

Conclusions Polymyalgia rheumatica is associated with increased aortic stiffness which may improve upon reduction of systemic inflammation induced by treatment with glucocorticoids.

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Footnotes

  • Competing interests None

  • Patient consent Obtained.

  • Ethics approval Ethics approval was obtained from the Ethics Committee, University of Perugia, Perugia, Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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