Polymyalgia rheumatica and giant cell arteritis

doi:10.1016/S0950-3579(05)80256-0

Baillière's Clinical Rheumatology

Volume 9, Issue 3, August 1995, Pages 515-527

https://doi.org/10.1016/S0950-3579(05)80256-0 Get rights and content

Summary

The original descriptions of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in the medical literature date back to 1888 and 1890, respectively. Classification criteria for PMR and GCA are not standardized since most authors used subjective criteria based on their personal experience. Only one study has evaluated criteria for PMR and has found seven variables with high discriminant value. Criteria for GCA are less varied because a positive biopsy of the temporal artery is diagnostic. However, combinations of different clinical and laboratory features have been used for diagnosis when biopsy is negative or missing.

Assessment of PMR/GCA is based on the serial determination of markers of acute phase such as ESR, CRP, or plasma viscosity. However, their value in predicting recurrence of the diseases is poor. New immunological factors including soluble interleukin-2 receptors, interleukin-6, serum soluble CD8, and serum soluble intercellular adhesion molecule-1 are presently under investigation.

References (60)

BerlitP
Clinical and laboratory findings with giant cell arteritis
Journal of the Neurological Sciences
(1992)
HamrinB et al.
Arteritis in ‘polymyalgia rheumatica’
Lancet
(1964)
HealeyLA
Long term follow up of polymyalgia rheumatica: evidence of synovitis
Al HussainiAS et al.
Peripheral joint involvement in polymyalgia rheumatica: a clinical study of 56 cases
British Journal of Rheumatology
(1985)
ArnettFC et al.
The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis
Arthritis and Rheumatism
(1988)
ArnoldMH et al.
The sensitivity and specificity of reduced CD8 lymphocyte levels in the diagnosis of polymyalgia rheumatica/giant cell arteritis
Clinical and Experimental Rheumatology
(1993)
AstionML et al.
Application of neural networks to the classification of giant cell arteritis
Arthritis and Rheumatism
(1994)
BagratuniL
A rheumatoid syndrome occurring in the elderly
Annals of the Rheumatic Diseases
(1953)
BagratuniL
Prognosis in the anarthritic rheumatoid syndrome
British Medical Journal
(1963)
BarberHS
Myalgic syndrome with constitutional effects: polymyalgia rheumatica
Annals of the Rheumatic Diseases
(1957)

BengtssonB-Å et al.

The epidemiology of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. Incidences of different clinical presentations and eye complications

Arthritis and Rheumatism

(1981)

BengtssonB-Å et al.

Giant cell arteritis

Acta Medica Scandinavica

(1982)

BirdHA et al.

An evaluation of criteria for polymyalgia rheumatica

Annals of the Rheumatic Diseases

(1979)

BlochDA et al.

Statistical approaches to classification. Methods for developing classification and other criteria rules

Arthritis and Rheumatism

(1990)

BruceW

Senile rheumatic gout

British Medical Journal

(1888)

ChmelewskiWL et al.

Presenting features and outcome in patients undergoing temporal artery biopsy

Archives of Internal Medicine

(1992)

ChuangTY et al.

Polymyalgia rheumatica. A 10 year epidemiological and clinical study

Annals of Internal Medicine

(1982)

CimminoMA et al.

A seasonal pattern in the onset of polymyalgia rheumatica

Annals of the Rheumatic Diseases

(1990)

CimminoMA et al.

Long term treatment of polymyalgia rheumatica with deflazacort

Annals of the Rheumatic Diseases

(1994)

DasguptaB et al.

Selective depletion and activation of CD8+ lymphocytes from peripheral blood of patients with polymyalgia rheumatica and giant cell arteritis

Annals of the Rheumatic Diseases

(1989)

DequekerJ

Rheumatic diseases in visual art. General review

DixonAStJ et al.

Polymyalgia rheumatica and temporal arteritis

Annals of the Rheumatic Diseases

(1966)

EllisME et al.

The ESR in the diagnosis and management of the polymyalgia rheumatica/giant cell arteritis syndrome

Annals of the Rheumatic Diseases

(1983)

FedericiAB et al.

Elevation of von Willebrand factor is independent of erythrocyte sedimentation rate and persists after glucocorticoid treatment in giant cell arteritis

Arthritis and Rheumatism

(1984)

Fernandez-SueiroL et al.

Validation of the 1990 American College of Rheumatology criteria for the classification of giant cell arteritis (GCA)

Arthritis and Rheumatism

(1993)

ForestierJ et al.

Pseudopolyarthrite rhizomélique

Revue du Rhumatisme et des Maladies Osteoarticulaires

(1953)

FranzénP et al.

Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984–1988

Journal of Rheumatology

(1992)

GilmourJR

Giant cell chronic arteritis

Journal of Pathology

(1941)

GudmundssonM et al.

Plasma viscosity in giant cell arteritis as a predictor of disease activity

Annals of the Rheumatic Diseases

(1993)

HamiltonCR et al.

Giant cell arteritis: including temporal arteritis and polymyalgia rheumatica

Medicine

(1971)

Cited by (13)

Neurologic involvement and new imaging contributions for giant cell arteritis diagnosis
2021, Pratique Neurologique - FMC
L’artérite à cellules géantes est une vascularite granulomateuse primitive du sujet de plus de 50 ans. Reconnue depuis plus d’un siècle, elle a été décrite sous sa forme typique associant des signes constitutionnels, des céphalées et une atteinte ophtalmique souvent sévère. Depuis, le spectre de la maladie s’est élargi par la description de la pseudo-polyarthrite rhizomélique rhumatisme inflammatoire fréquemment associé et dont le substratum physiopathogénique semble commun, mais aussi par l’identification de sous-types de la maladie en fonction de la localisation de l’atteinte artérielle. Les branches de la carotide externe, principalement l’artère temporale et les branches de la carotide interne, principalement l’artère ophtalmique demeurent des atteintes de prédilection de la maladie. Elles sont source des principales manifestations neuro-ophtalmologiques de la maladie. Les accidents vasculaires cérébraux sont en effet une complication redoutable, source de morbidité et de mortalité plus importante comparativement à la population générale. Les céphalées et une amaurose peuvent en être les signes annonciateurs. Une autre forme de la maladie incluant l’atteinte des gros troncs artériels (aorte, membres supérieurs et membres inférieurs) est également décrite et peut survenir de manière isolée ou associée à la forme précédente, responsable de complications telles que des anévrysmes artériels, des dissections, mais aussi des sténoses. Les progrès de l’imagerie ont permis des avancées, à la fois dans l’identification du siège des atteintes possibles de la maladie mais aussi par la description précise de signes radiologiques diagnostiques dont les sensibilité et spécificité rivalisent avec l’apport diagnostique de l’étude histologique de la biopsie de l’artère temporale, encore considérée comme le gold standard pour établir le diagnostic de certitude. Cet article a pour objectif de dresser les principales caractéristiques cliniques et morphologiques de la maladie à la lumière des nouvelles connaissances de la maladie. Une attention particulière y sera accordée pour les manifestations neurologiques centrales et neuro-ophtalmologiques, principales sources de morbidité et de mortalité.
Giant cell arteritis is a primitive granulomatous vasculitis affecting subjects more than 50 years old. Recognized for more than a century, its typical form was described as including constitutional signs, headaches, and severe ophthalmic involvement. The disease spectrum has since widened by the description of polymyalgia rheumatica, which is an often-associated inflammatory rheumatism whose pathogenic substratum appears common, but also by the identification of disease subtypes along with arterial localization. The branches of the external carotid artery, essentially the temporal artery, and the branches of the internal carotid artery, essentially the ophthalmic artery, remain classical disorders of the disease. They are the principal causes of the neuro-ophthalmologic manifestations. Strokes are a fearsome complication, associated with greater morbidity and mortality than in the general population. Headaches and amaurosis are sometimes warning signs for stroke. Another form of the disease including large-vessel involvement (aorta, upper and lower artery limbs) is also described. It can occur isolated or associated with the precedent form leading to complications such as arterial aneurysm, dissections, and stenosis. Progress in imaging has helped advance both the identification of possible sites of the disease and the precise description of diagnostic signs, whose sensitivity and specificity rival those of the diagnosis contribution of the temporal artery histological study, still considered as the gold standard for diagnosis. This article aims so to describe the main clinical and morphological characteristics of giant cell arteritis in light of recent advances in knowledge. Special attention will be given to central neurological and neuro-ophthalmologic manifestations, which remain the main causes of morbidity and mortality in giant cell arteritis.
Lymphocytes expressing α1β1 integrin (very late antigen-1) in peripheral blood of patients with arthritis are a subset of CD45RO<sup>+</sup> T-cells primed for rapid adhesion to collagen IV
2002, Clinical Immunology
We report that very late antigen-1 (VLA-1⁺) CD3⁺CD45RO⁺ T-cells are selectively segregated from VLA-1⁻ peripheral blood (PB) mononuclear cells (MC), in which CD3⁺ T-cells are evenly CD45RO⁺ and CD45RO⁻, when PBMC are stained with a monoclonal antibody (mAb) to VLA-1 and passaged on immunomagnetic columns. In contrast, both VLA-1⁺ and VLA-1⁻ MC isolated from synovial fluid (SF) are mainly CD45RO⁺CD3⁺ T-cells. VLA-1⁺ MC formed 13 ± 5.3% of MC eluting from columns loaded with PBMC of patients with seropositive rheumatoid arthritis (n = 6) and 2.3 ± 1.6% of patients (n = 4) with other arthritides (P < 0.022). Importantly, only the VLA-1⁺ MC from PB and SF adhered to collagen IV upon triggering with phorbol 12-myristate 13-acetate. Moreover, adhesion and migration on collagen IV were preferentially maintained in lines cultured from VLA-1⁺ T-cells, and both were inhibited by mAb to the VLA-1 α1 I domain. These results suggest that VLA-1⁺ CD45RO⁺ T-cells in patients with arthritis could play a role in both systemic and local inflammation by rapidly adhering to collagen IV.
Pathogenesis of polymyalgia rheumatica
2018, Reumatismo
The correct prednisone starting dose in polymyalgia rheumatica is related to body weight but not to disease severity
2011, BMC Musculoskeletal Disorders
Giant cell arteritis: The history
2006, Zeitschrift fur Rheumatologie
Remitting seronegative symmetrical synovitis with pitting oedema/polymyalgia rheumatica after infection with Mycoplasma pneumoniae
2005, Annals of the Rheumatic Diseases

View all citing articles on Scopus

View full text

Polymyalgia rheumatica and giant cell arteritis

Summary

Journal of the Neurological Sciences

Lancet

Peripheral joint involvement in polymyalgia rheumatica: a clinical study of 56 cases

British Journal of Rheumatology

The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis

Arthritis and Rheumatism

The sensitivity and specificity of reduced CD8 lymphocyte levels in the diagnosis of polymyalgia rheumatica/giant cell arteritis

Clinical and Experimental Rheumatology

Application of neural networks to the classification of giant cell arteritis

Arthritis and Rheumatism

A rheumatoid syndrome occurring in the elderly

Annals of the Rheumatic Diseases

Prognosis in the anarthritic rheumatoid syndrome

British Medical Journal

Myalgic syndrome with constitutional effects: polymyalgia rheumatica

Annals of the Rheumatic Diseases

The epidemiology of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. Incidences of different clinical presentations and eye complications

Arthritis and Rheumatism

Giant cell arteritis

Acta Medica Scandinavica

An evaluation of criteria for polymyalgia rheumatica

Annals of the Rheumatic Diseases

Statistical approaches to classification. Methods for developing classification and other criteria rules

Arthritis and Rheumatism

Senile rheumatic gout

British Medical Journal

Presenting features and outcome in patients undergoing temporal artery biopsy

Archives of Internal Medicine

Polymyalgia rheumatica. A 10 year epidemiological and clinical study

Annals of Internal Medicine

A seasonal pattern in the onset of polymyalgia rheumatica

Annals of the Rheumatic Diseases

Long term treatment of polymyalgia rheumatica with deflazacort

Annals of the Rheumatic Diseases

Selective depletion and activation of CD8+ lymphocytes from peripheral blood of patients with polymyalgia rheumatica and giant cell arteritis

Annals of the Rheumatic Diseases

Rheumatic diseases in visual art. General review

Polymyalgia rheumatica and temporal arteritis

Annals of the Rheumatic Diseases

The ESR in the diagnosis and management of the polymyalgia rheumatica/giant cell arteritis syndrome

Annals of the Rheumatic Diseases

Elevation of von Willebrand factor is independent of erythrocyte sedimentation rate and persists after glucocorticoid treatment in giant cell arteritis

Arthritis and Rheumatism

Validation of the 1990 American College of Rheumatology criteria for the classification of giant cell arteritis (GCA)

Arthritis and Rheumatism

Pseudopolyarthrite rhizomélique

Revue du Rhumatisme et des Maladies Osteoarticulaires

Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984–1988

Journal of Rheumatology

Giant cell chronic arteritis

Journal of Pathology

Plasma viscosity in giant cell arteritis as a predictor of disease activity

Annals of the Rheumatic Diseases

Giant cell arteritis: including temporal arteritis and polymyalgia rheumatica

Medicine