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WASHINGTON, D.C.—From diagnosis questions to infection risk to treatment decisions, handling giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) comes with a range of challenges for clinicians. Speaking in the ACR Review Course at the 2016 ACR/ARHP Annual Meeting, an expert—Rebecca Manno, MD, MHS, assistant professor of medicine in rheumatology at Johns Hopkins, as well as a fan of boating—likened the challenges to those faced by a boater: You have to remember to call things by the right name (definitions and classification criteria); beware of submerged objects (such as large-vessel vasculitis); be prepared for storms (venous thrombosis, infections and challenges with temporal artery biopsy); and use the right tools (therapies).
GCA, a systemic vasculitis of medium and large arteritis, is the most common form of vasculitis in Europe and North America. It affects women more than men, and older age and genetics are key risk factors. PMR, an inflammatory syndrome that targets the shoulder and hip girdle region, has similar demographics as GCA.
The two diseases are linked: Studies have shown that between 40 and 60% of those with GCA are also affected by PMR, and between 16 and 21% of those with PMR are affected by GCA.
Rose M. Stoeffler says
March 25, 2017 at 7:18 pmJust one week ago I was diagnosed with PMR. The first doses of cortisone worked like a miracle. First time pain free in five months… but as the doses were smaller (in a six pack) some pain returned, but not what I had been experiencing. When asked by the rheumatologist about morning stiffness, I replied fifteen, twenty minutes. Now I see that it should be more than 45 minutes. Problem was with the definition of stiffness. I forced my self to walk twice each morning before I was really starting to walk like a human and not a robot. Stiffness and aching continue until what I call the magic time… about noon to two I had some relief… My point is that being more specific in using words would help. I thank God that I found a rheumatologist who made the diagnosis.
Alfred Miller,M.D. says
July 4, 2017 at 6:54 amThe identical clinical presentation pf both Polymyalgia Rheumatica and Giant Cell Arteritis have been reported with Borreliosis (Lyme Disease).
Biopsy specimens of the Temporal Artery have documented the presence of the spirochetes.
This article does not mention this alternative diagnosis.
Furthermore, Steroids are contraindicated in an infection.
Lyme Disease MUST be PROPERLY ruled out in every case of PMR and Giant Cell Arteritis !
https://www.ncbi.nlm.nih.gov/pubmed/22420373