Development of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica: study of a series of 100 patients.
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.
Hernández-Rodríguez
José
J
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.
Font
Carme
C
García-Martínez
Ana
A
Espígol-Frigolé
Georgina
G
Sanmartí
Raimon
R
Cañete
Juan D
JD
Grau
Josep M
JM
Cid
Maria C
MC
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*
D005938:Glucocorticoids; D011241:Prednisone