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Clinical features of polymyalgia rheumatica and giant cell arteritis

Published on Sep 1, 2012in Nature Reviews Rheumatology18.545
· DOI :10.1038/nrrheum.2012.97
Carlo Salvarani73
Estimated H-index: 73
,
Nicolò Pipitone38
Estimated H-index: 38
+ 1 AuthorsGene G. Hunder76
Estimated H-index: 76
(Mayo Clinic)
Abstract
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders that commonly occur in the elderly and whose disease patterns variably overlap. In this Review, Salvarani and colleagues describe the main clinical features of both PMR and GCA, detailing the pathogenesis, diagnosis, classification and management of these disorders, offering practical guidance to clinicians.
  • References (152)
  • Citations (101)
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References152
Newest
Background Temporal artery biopsy (TAB) is the gold standard to diagnose giant cell arteritis (GCA), but is negative in approximately 20% of patients Objectives The study aimed to establish whether Color-doppler-ultrasonography (CDU)-guided TAB might provide a greater yield compared to standard TAB technique in patients with GCA Methods We enrolled 100 consecutive patients suspected of having GCA from September 2009 through December 2011. The average age of patients was 74 years. At randomizatio...
1 CitationsSource
#1Shantel Fernandez (Tripler Army Medical Center)H-Index: 1
#2Lisa DeMarni Cromer (TU: University of Tulsa)H-Index: 11
Last. Joanne L. Davis (TU: University of Tulsa)H-Index: 23
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Two case studies are presented to demonstrate that children who experience trauma-related nightmares may benefit from cognitive-behavioral therapy for this sleep problem. The treatment was adapted from the empirically supported adult treatment for chronic trauma-related night- mares: exposure, relaxation, and rescripting therapy (ERRT). Pretreatment and posttreatment nightmare frequency and severity were measured in addition to subjective nightmare-related distress, behavioral problems, sleep qu...
401 CitationsSource
#1Benjamin Terrier (UPMC: Pierre-and-Marie-Curie University)H-Index: 38
#2G. Geri (UPMC: Pierre-and-Marie-Curie University)H-Index: 10
Last. Patrice Cacoub (UPMC: Pierre-and-Marie-Curie University)H-Index: 60
view all 13 authors...
Objective Giant cell arteritis (GCA) is a large-vessel vasculitis of unknown origin. Recent findings indicate that at least 2 separate lineages of CD4+ T cells, Th1 and Th17 cells, participate in vascular inflammation. The pathways driving these T cell differentiations are incompletely understood, but may provide novel therapeutic targets. This study was undertaken to identify cytokines involved in the pathogenesis of GCA. Methods Thirty GCA patients fulfilling the American College of Rheumatolo...
84 CitationsSource
#1Anna Enjuanes (University of Barcelona)H-Index: 26
#2Yolanda Benavente (University of Barcelona)H-Index: 28
Last. Maria C. Cid (University of Barcelona)H-Index: 51
view all 9 authors...
Objective. Frequent genetic variants may be associated with GCA. Existing studies have analysed a limited number of candidate genes and genetic variants. To expand this information, we performed a casecontrol study genotyping 130 single nucleotide polymorphisms (SNPs) in 82 biopsy-proven GCA patients and 166 healthy controls from the Spanish population. Methods. SNPs in coding and regulatory gene regions of 14 candidate genes (CCL2, CCR7, IL10, IL12A, IL1A, IL1B, IL1RN, IL6, IL8, INFG, LTA, NOS2...
31 CitationsSource
#1Eric L. Matteson (Mayo Clinic)H-Index: 68
#2Hilal Maradit-Kremers (Mayo Clinic)H-Index: 51
Last. Bhaskar Dasgupta (Southend University Hospital NHS Foundation Trust)H-Index: 35
view all 38 authors...
Objective. To prospectively evaluate the disease course and the performance of clinical, patient-reported outcome (PRO) and musculoskeletal ultrasound measures in patients with polymyalgia rheumatica (PMR). Methods. The study population included 85 patients with new-onset PMR who were initially treated with prednisone equivalent dose of 15 mg daily tapered gradually, and followed for 26 weeks. Data collection included physical examination findings, laboratory measures of acute-phase reactants, a...
37 CitationsSource
#1Bhaskar Dasgupta (Southend University Hospital NHS Foundation Trust)H-Index: 35
#2Marco A. Cimmino (UniGe: University of Genoa)H-Index: 37
Last. Eric L. Matteson (Mayo Clinic)H-Index: 68
view all 42 authors...
The objective of this study was to develop EULAR/ACR classification criteria for polymyalgia rheumatica (PMR). Candidate criteria were evaluated in a 6-month prospective cohort study of 125 patients with new onset PMR and 169 non-PMR comparison subjects with conditions mimicking PMR. A scoring algorithm was developed based on morning stiffness >45 minutes (2 points), hip pain/limited range of motion (1 point), absence of RF and/or ACPA (2 points), and absence of peripheral joint pain (1 point). ...
257 CitationsSource
#1G. RestucciaH-Index: 10
#2Alberto CavazzaH-Index: 38
Last. Carlo SalvaraniH-Index: 73
view all 12 authors...
Objective To evaluate the frequency and clinical characteristics of periadventitial small-vessel vasculitis (SVV) and isolated vasa vasorum vasculitis (VVV). Methods We identified 455 temporal artery biopsies performed in residents of Reggio Emilia, Italy between 1986 and 2003. Slides of temporal artery biopsy specimens were reviewed by a pathologist who was blinded with regard to clinical data. SVV was defined as inflammation of the small vessels external to the temporal artery adventitia, and ...
43 CitationsSource
Objectives. Imaging is one of the most appealing techniques to explore PMR, a disease whose causes, development mechanisms and anatomical targets of inflammatory damage are still scarcely known. This review is concerned with an appraisal of PMR with different imaging modalities with a view to highlighting possible clues to its pathogenesis, diagnosis and prognosis.Methods. A systematic literature research was performed searching PubMed until July 2010. The Cochrane Library was searched for the r...
63 CitationsSource
#1Carlo Salvarani (UNIBO: University of Bologna)H-Index: 73
#2Luca Magnani (UNIBO: University of Bologna)H-Index: 25
Last. Luigi Boiardi (UNIBO: University of Bologna)H-Index: 40
view all 9 authors...
Objective. Treatment of large-vessel vasculitis (LVV) remains challenging. Patients usually respond to glucocorticoid (GC) therapy, but often relapse on tapering of the GC dose or after GC withdrawal. In addition, GCs are fraught with numerous adverse events. The aim of this study was to assess the efficacy and safety of the anti-IL-6 receptor (IL-6R) antibody tocilizumab (TCZ) in patients with LVV. Methods. Four patients with active LVV (two with GCA and two with Takayasu arteritis) received mo...
169 CitationsSource
#1Sudha Visvanathan (Cleveland Clinic Lerner College of Medicine)H-Index: 17
#2Mahboob Rahman (Cleveland Clinic Lerner College of Medicine)H-Index: 59
Last. Maria C. Cid (Cleveland Clinic Lerner College of Medicine)H-Index: 51
view all 10 authors...
Objective. To evaluate the association between inflammatory markers and relapse in GCA patients longitudinally assessed in a clinical trial of infliximab and glucocorticosteroids. Methods. Forty-four newly diagnosed GCA patients in glucocorticosteroid-induced remission were randomized to receive infliximab 5 mg/kg or placebo plus daily glucocorticosteroids, tapered using a standardized schedule. Sera were analysed for inflammatory markers at multiple, pre-defined time points. Temporal artery bio...
58 CitationsSource
Cited By101
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Abstract Objective To evaluate characteristics and predictors of relapses and long-term remission in an Italian cohort of patients with large-vessel (LV) giant cell arteritis (GCA). Methods We evaluated 87 consecutive patients with LV-GCA followed up at the Rheumatology Unit of Reggio Emilia Hospital (Italy) for at least 2 years. Patients with relapses and long-term remission were compared to those without. A group of 34 patients with biopsy proven GCA without LV vasculitis (LVV) at diagnosis wa...
Source
#1Luka Bolha (University of Ljubljana)H-Index: 4
#2Jože Pižem (University of Ljubljana)H-Index: 8
Last. Vesna Jurčić (University of Ljubljana)H-Index: 8
view all 6 authors...
OBJECTIVES To identify dysregulated microRNAs (miRNAs) and their gene targets in temporal arteries from GCA patients, and determine their association with GCA pathogenesis and related arterial wall remodelling. METHODS We included 93 formalin-fixed, paraffin-embedded temporal artery biopsies (TABs) from treatment-naive patients: 54 positive and 17 negative TABs from clinically proven GCA patients, and 22 negative TABs from non-GCA patients. miRNA expression analysis was performed with miRCURY LN...
Source
#1Elena Galli (University of Modena and Reggio Emilia)H-Index: 2
#2Francesco MuratoreH-Index: 17
Last. Nicolò PipitoneH-Index: 38
view all 14 authors...
Abstract Objective To evaluate the characteristics and significance of inflammation restricted (RI) to the adventitial and/or periadventitial tissue on temporal artery biopsy (TAB). Methods We studied a retrospective cohort of 80 patients with RI, extending our earlier series of 39 patients. For comparison purposes, we collected the same data from 254 patients with transmural inflammation (TMI) and 81 TAB-negative patients. A review of the literature was also performed. Results A final diagnosis...
Source
#1Patrícia MartinsH-Index: 2
#2Vitor H. TeixeiraH-Index: 18
Last. Cristina PonteH-Index: 12
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Giant cell arteritis (GCA) is a granulomatous vasculitis involving large- and middle-sized arteries, with a predilection for cranial arteries. In this paper, we aim to describe a case of a biopsy- and ultrasound-proven GCA, presenting with anterior ischemic optic neuropathy (AION) and normal CRP and ESR at diagnosis and during follow-up, and to review the literature on GCA cases with low inflammatory markers, with a particular focus on the presence of eye involvement. Both CRP and ESR are import...
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#1Shihoko Nakajima (Juntendo University)H-Index: 1
#2Asako Chiba (Juntendo University)H-Index: 16
Last. Sachiko Miyake (Juntendo University)H-Index: 47
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OBJECTIVES: Although T cells are thought to be involved in the pathogenesis of PMR, whether innate-like T cells are involved in the process remains unknown. METHODS: The serum levels of 27 cytokines/chemokines in patients with PMR were measured by a multiplex immunoassay (Bio-Plex Assay). The cytokine-producing capacity of T and innate-like T cells was assessed by intracellular cytokine staining and flow cytometry. The frequency and activated status of T and innate-like T cells were investigated...
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Last. Hubert de Boysson (UNICAEN: University of Caen Lower Normandy)H-Index: 14
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Objective To identify characteristics and factors associated with relapse and glucocorticoid (GC) dependence in patients with giant-cell arteritis (GCA). Methods We retrospectively analyzed 326 consecutive patients with GCA followed for at least 12 months. Factors associated with relapse and GC dependence were identified in multivariable analyses. Results The 326 patients (73% women) were followed up for 62 [12—262] months. During follow-up, 171 (52%) patients relapsed, including 113 (35%) who d...
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#1Mel Mupparapu (UPenn: University of Pennsylvania)H-Index: 5
#2Eugene Ko (UPenn: University of Pennsylvania)
Last. Avneesh Chhabra (UTSW: University of Texas Southwestern Medical Center)H-Index: 31
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The maxillofacial region is complex in its anatomy and in its variation in the presentation of neurologic disorders. The diagnosis and management of neurologic disorders in clinical practice remains a challenge. A good understanding of the neurologic disorder in its entirety helps dentists in the diagnosis and appropriate referral to a specialist for further investigations and management of the condition. Neurologic disorders described in this article are under broad categories of sensory and mo...
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#1Sayena Jabbehdari (UIC: University of Illinois at Chicago)H-Index: 7
Last. Karl C. Golnik (UC: University of Cincinnati)H-Index: 21
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A variety of conditions may present with symptoms and signs that overlap between the subspecialties of oculoplastics and neuro-ophthalmology. Ideally, co-management of these conditions will be possible but in reality, these subspecialties are under-represented around the world and thus, this may not be feasible. This chapter provides an overview of the most common overlapping conditions and attempts to emphasize the most critical clinical and therapeutic considerations.
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#1Lucia LeccisottiH-Index: 12
Last. Alessandro Giordano (UCSC: Catholic University of the Sacred Heart)H-Index: 34
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Purpose This mini-review aims to qualitatively analyze the diagnostic performance of FDG PET in patients with diagnosis or suspected large vessel vasculitis (LVV). The future perspectives of PET in this field are also described.
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#1Melvin L. H. Ling (UNSW: University of New South Wales)
#2Jason Yosar (UQ: University of Queensland)
Last. Ian C. Francis (UNSW: University of New South Wales)H-Index: 19
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Temporal arteritis (TA), or giant cell arteritis, is a systemic autoimmune vasculitis affecting patients over 50 years of age. It can cause rapid, irreversible bilateral vision loss in older adults and is therefore considered an ophthalmological emergency. Many of the symptoms and signs of TA can be vague, non-specific and gradual in onset, often leading to a delayed or inaccurate diagnosis. As such, it is important for a wide variety of primary optometrists and health practitioners to maintain ...
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