SAT0254 PROSPECTIVE ANALYSIS OF THE PREVALENCE OF GIANT CELL ARTERITIS IN CONSECUTIVE PATIENTS WITH POLYMYALGIA RHEUMATICA
Authors: L. C. Burg, C. Behning, P. Brossart, V. S. Schäfer
Journal: Annals of the Rheumatic Diseases (2020)

Background: Giant cell arteritis (GCA) is the most common form of systemic vasculitis affecting people aged 50 years and older. 1 Although it is known, that GCA often coexists with polymyalgia rheumatica (PMR) 2 , prevalence of GCA in consecutive patients with PMR has not been investigated Objectives: To prospectively examine the prevalence of GCA in consecutive patients with PMR by vascular ultrasound (US). Methods: Patients with newly diagnosed PMR fulfilling the ACR /EULAR classification criteria 3 were included. Vascular US examination of the extracranial arteries typically involved in GCA, such as axillary arteries, vertebral arteries, common carotid arteries, superficial temporal arteries with both frontal and parietal branches, occipital arteries, facial arteries and the central retinal arteries was performed in all PMR patients. Diagnosis of GCA was made, if intima-media thickness (IMT) was above respective cut-off values. 4 Results: Fifty patients with diagnosis of PMR underwent vascular US. Twenty-three patients (46%) had PMR without GCA (PMR-group). The mean age in this group was 71 years (SD ± 10) with seventeen (73%) females. In twenty-seven PMR patients (54%) GCA was diagnosed (GCA-PMR group); the mean age in this group was 74 years (SD ± 9) with ten (37%) females respectively. Mean C-reactive protein (CRP) values were 29.4 mg/l (SD±24.5) in the PMR-group and 52.2 mg/l (SD±43.2) in the GCA-PMR-group. Although different mean values between the PMR-group and the GCA-PMR-group were observed, CRP values did not differ significantly between the two groups (p = 0.1432). Ten (37%) patients of the GCA-PMR group did not have GCA symptoms and diagnosis of GCA was only determined by ultrasound examination. Symptoms and numbers of patients with respective symptoms are depicted in Table 1 and 2. Table 1. Symptoms and signs in both groups Symptoms and signs Group PMR-group GCA-PMR-group Morning stiffness 22 (95%) 23 (85%) ≥1 shoulder with synovits or bursitis trochanterica 12 (52%) 13 (48%) ≥1 shoulder or hip with synovitis or bursitis 11 (48%) 14 (51%) hip pain 23 (100%) 23 (85%) No other joints affected 22 (95%) 26 (96%) PMR-group: patients with diagnosis of polymyalgia rheumatica only GCA-PMR-group: patients with diagnosis of polymyalgia rheumatic and giant cell arteritis Conclusion: Prevalence of GCA in patients with PMR in our cohort was 54%. Ten (37%) patients with GCA and PMR did not have any GCA symptoms. Performing vascular US in patients with PMR can be useful to diagnose a clinical inapparent GCA. Prompt onset of the respective therapy could prevent complications of GCA and improve disease outcome. References: [1]Warrington KJ, Matteson EL. Management guidelines and outcome measures in giant cell arteritis (GCA). Clin Exp Rheumatol 2007;25:137–41 [2]Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. The Lancet 2008;372:234–45. [3]Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum 2012;64:943–54. [4]Schäfer VS, Juche A, Ramiro S, Krause A, Schmidt WA. Ultrasound cut-off values for intima-media thickness of temporal, facial and axillary arteries in giant cell arteritis. Rheumatology (Oxford) 2017;56:1479–83. Table 2. Number of patients in each group with symptoms of giant cell arteritis Symptoms Group PMR-group GCA-PMR-group Visual symptoms 2 (9%) 8(30%) Headache 2 (9%) 9 (33%) Jaw claudication 4 (18%) 10 (38%) Scalp tenderness 0 (0%) 5 (19%) No GCA symptoms 15 (65%) 10 (37%) PMR-group: patients with diagnosis of polymyalgia rheumatica only GCA-PMR-group: patients with diagnosis of polymyalgia rheumatic and giant cell arteritis Disclosure of Interests: None declared