title: Development of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica: study of a series of 100 patients.
abstract: Several studies suggest that patients with giant cell arteritis (GCA) presenting with isolated polymyalgia rheumatica (PMR) with no cranial symptoms are at low risk of suffering GCA-related ischemic events. However, the issue remains controversial. In the current study we assessed the development of ischemic events in a large series of GCA patients who suffered from apparently isolated PMR during the main course of their disease. One hundred GCA patients presenting with PMR only for at least 2 months were selected from among 347 individuals with biopsy-proven GCA. Clinical manifestations and their chronologic appearance before diagnosis were recorded. Seventy-three patients presented with isolated PMR for a median of 8 months (range, 2 mo-5 yr) and later developed cranial symptoms for a median of 3 weeks (range, 0 wk-1 yr), which eventually led to GCA diagnosis (Group 1). The remaining 27 patients, after presenting a self-limiting course of dismissed mild cranial symptoms lasting for a median of 2 weeks (range, 1 wk-4 mo), developed PMR, which was their chief complaint for a median of 3 months (range, 2 mo-1.5 yr) and the reason for medical evaluation (Group 2). Twenty (27.4%) patients in Group 1 suffered disease-related ischemic complications at the time of diagnosis. No patient in Group 2 developed ischemic events. Patients with GCA presenting with apparently isolated PMR are not a benign subset and have a significant risk of developing ischemic complications. Among them, the only patients who appear to be at low risk of developing ischemic events are those in whom a self-limiting episode of cranial symptoms can be recorded.
authors.affiliation: From Vasculitis Research Unit, Department of Internal Medicine (JH-R, CF, AGM, GE-F, JMG, MCC) and Department of Rheumatology (RS, JDC), Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Rodríguez
authors.forename: Carme
authors.initials: C
authors.lastname: Font
authors.forename: Ana
authors.initials: A
authors.lastname: García-Martínez
authors.forename: Georgina
authors.initials: G
authors.lastname: Espígol-Frigolé
authors.forename: Raimon
authors.initials: R
authors.lastname: Sanmartí
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
authors.forename: Josep M
authors.initials: JM
authors.lastname: Grau
authors.forename: Maria C
authors.initials: MC
authors.lastname: Cid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000209:etiology; D001766:Blindness / Q000209:etiology*; D005260:Female; D013700:Giant Cell Arteritis / Q000150:complications*; D005938:Glucocorticoids / Q000627:therapeutic use; D006261:Headache / Q000209:etiology; D006801:Humans; D007571:Jaw Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000209:etiology*; D011111:Polymyalgia Rheumatica / Q000150:complications* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D020521:Stroke / Q000209:etiology*
chemical_list: D005938:Glucocorticoids; D011241:Prednisone