Polymyalgia rheumatica and giant cell arteritis – first results of a year-long study

Czech version

Authors: J. Rovenský ¹; A. Tuchyňová ¹; P. Poprac ¹; S. Blažíčková ¹; V. Bošák ¹; V. Štvrtinová ²
Authors‘ workplace: Národný ústav reumatických chorôb, Piešťany, Slovenská republika, riaditeľ prof. MUDr. Jozef Rovenský, DrSc., FRCP ¹; II. interná klinika Lekárskej fakulty UK FN Bratislava, Slovenská republika, prednosta prof. MUDr. Andrej Dukát, DrSc., FESC ²
Published in: Vnitř Lék 2006; 52(7-8): 691-696
Category: 130th Internal Medicine Day - Rheumatology in clinical practice

Overview

Introduction:
Due to ageing of population, gerontorheumatology becomes more and more important. Both polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) typically develop in later life and they have many other common features. The aim of our study was to explore diagnostic and prognostic markers and, prospectively, establish diagnostic and therapeutic algorithm for patients with PMR and GCA.

Sample and methods:
We examined 27 patients with suspected PMR or OBA. The diagnosis was verified in 22 patients. Three of them were in a long-term clinical remission. Besides examination for basic clinical and laboratory parameters all other patients were subjected to ultrasonography of temporal artery and peripheral joints to detect any exudates. Also, they were examined for T-cell subpopulations in peripheral blood and HLA antigens.

Results:
Exudate was confirmed in 7 patients; some of them had exudate in multiple joints. Puncture of synovial fluid was done in 4 patients. Increased resistance index of temporal artery was found in 2 patients with GCA and 4 patients with PMR. GCA patients showed lower level of T-cells and increased activation of CD8-cells. Decreased count of CD8+ T-cells was observed in 56 % of PMR patients. Analysis of HLA and increased activation of CD8-cells. Decreased count of CD8+ T-cells was observed in 56 % of PMR patients. Analysis of HLA antigens indicates that GCA, rheumatoid arthritis and, probably, PMR are associated with HLA-DR4 antigen in Slovak population.

Conclusion:
The importance of assessment of disease activity and its prognosis in PMR or GCA patients via ultrasonographic evaluation of exudate in peripheral joints and resistance index of temporal artery as well as the analysis of T-cell distribution in peripheral blood and incidence of HLA-antigens has not been proved yet. Practical significance of monitoring the above-mentioned parameters can be verified only by further prospective study performed with a larger sample of patients.

Key words:
polymyalgia rheumatica – giant cell arteritis – synovitis – HLA antigens – T-cell subpopulations

Sources

1. Bošák V. HLA-systém a jeho význam v reumatológii. In: Bošák V. Klinická reumatológia. Martin: Osveta 2000: 127-144.

2. Chaoaut D. Peripheral joint involvement in polymyalgia rheumatica. Rev Rhum (Engl Ed) 1997; 64: 184-188.

3. Chou Ch, Schumacher HR. Clinical and pathologic studies of synovitis in polymyalgia rheumatica. Arthritis Rheum 1984; 27: 1107-1117.

4. Gerster JC. Treatment of polymyalgia rehumatica. Rheumatol Eur 1996; 25: 30-32.

5. Koski JM. Ultrasonographic evidence of synovitis in axial joints in patients with polymyalgia rheumatica. Br J Rheumatol 1992; 31: 201-203.

6. Hayreh SS. Giant cell arteritis, diagnostic parameters. www.webeye.ophth.uiowa.edu/dept/GCA/03-diagnostic.

7. Font C, Cid MC, Coll-Vincent B et al. Clinical features in patients with permanent visual loss due to biopsy-proven giant cell arteritis. Br J Rheumatol 1997; 36: 251-254.

8. Hunder GG, Bloch DA, Michel BA et al. The American College of Rheumatology 1990 criteria for classification of giant cell arteritis. Arthritis Rheum 1990; 33: 1122-1128.

9. Lauwerys BR, Puttemans T, Houssiau FA et al. Color Doppler sonography of the temporal arteries in giant cell arteritis and polymyalgia rheumatica. J Rheumatol 1997; 24: 1570-1574.

10. Murgatroyd H, Nimmo M, Evans A et al. The use of ultrasound as an aid in the diagnosis of giant cell arteritis: a pilot study comparing histological features with ultrasound findings. Eye 2003; 17: 415-419.

11. Nesher G, Shemenh D, Mates M et al. The predictive value of the halo sign in color Doppler ultrasonography of the temporal arteries for the diagnosing giant cell arteritis. J Rheumatol 2002; 29: 1224-1226.

12. Schmidt WA. Doppler ultrasonography in the diagnosis of giant cell arteritis. Clin Exp Rheumatol 2000; 18(Suppl 20): S40-S42.

13. Banks PM, Cohen MD, Ginsburg WW et al. Immunohistologic and cytochemical studies of temporal arteritis. Arthritis Rheum 1983; 26: 1201-1207.

14. Andersson R, Hansson GK, Soderstrom T et al. HLA-DR expression in the vascular lesion and circulating T-lymphocytes of patients with giant cell arteritis. Clin Exp Immunol 1988; 73: 8287.

15. Uddhammar A, Roos G, Näsman B et al. Peripheral blood lymphocytes subsets in polymyalgia reumatica. Clin Rheumatol 1995; 14: 62-67.

16. Pountain GD, Keogan MT, Brown DL et al. Circulating T cell subtypes in polymyalgia reumatica and giant cell arteritis: variation in the proportion of CD8+ with prednisolone treatment. Ann Rheum Dis 1993; 52: 730-733.

17. Martinéz-Taboada VM, Gorozny JJ, Weyand CM. Clonally expanded CD8 T cells inpatients with polymyalgia reumatica and giant cell arteritis. Clin Immunol Immunopathol 1996; 79: 263-270.

18. Martinéz-Taboada VM, Blanco R, Fito C et al. Circulationg CD8+ T cell in polymyalgia reumatica and giant cell arteritis: a rewiew. Seminars in Arthritis and Rheum 2001; 30: 257-271.

19. Rosenthal M, Mullen W, Albert ED et al. HL-A antigens in 15 patients with polymyalgia rheumatica and in 1142 controls. N Eng J Med 1975; 292: 595.

20. Gonzalez-Guy MA. Genetic epidemioliogy of GCA and PMR. Arthritis Res 2001; 3: 1554-1157.

21. Weyand MC, Goronzy JJ. Molecular approaches toward pathologic mechanism in GCA and Takayasu´s arteritis. Curr Opin Rheumatol 1995; 7: 30-36.

22. Dababneh A, Gonzalez-Gay MA, Garcia-Porrua C et al. GCA and PMR can be differentiated by distinct patterns of HLA class II association. J Rheumatol 1998; 25: 2140-2145.

23. Salvarani C, Boiardi L, Mantovani V et al. HLA-DRB1 alleles associated with PMR in northern Italy. Ann Rheum Dis 1999; 58: 303-308.

24. Reviron D, Foutrier C, Gula S et al. DRB1 alleles in PMR and rheumatoid arthritis in southern France. Eur J Immunogenet 2001; 28: 83-87.

25. Gonzalez-Guy MA, Garcia-Porrua C, Hajeer AH et al. HLA-DRB1*04 may be a marker of severity in GCA. Ann Rheum Dis 2000; 59: 574-575.

26. Gonzalez-Guy MA, Hajeer AH, Dababneh A et al. Seronegative rheumatoid arthritis in elderly and PMR have similar patterns of HLA association. J Rheumatol 2001; 28, 122-125.