Background/Purpose
Large Vessel Vasculitis (LVV) can present with heterogeneous clinical manifestations, which range from general symptoms (fever, loss of weight) to the classic symptoms of Giant Cells Arteritis (GCA) (headache, jaw claudication, visual manifestations). Around 40% of GCA patients have concomitant Polymyalgia Rheumatica (PMR) and up to 40% of PMR patients have a positive biopsy of the temporal artery (TAB).
Studies evaluating ultrasound (US) as a diagnostic tool in GCA have reported a high sensivity and specificity.
The aim of this study was to investigate the association between disease’s relapse and co-existing “silence” LVV in patients with pure PMR.
Methods
Patients with PMR who relapsed under corticosteroid (CS) tapering In Esbjerg Hospital, Denmark in the period of April 2013 to June 2014 have been prospectively included. In patients with PMR who relapsed under corticosteroid (CS) tapering, US examination of temporal (AT), axillary (AA), subclavian (AS) and carotid (AC) arteries was performed. US images were recorded and evaluated by an ultrasonographer experienced on vascular ultrasound (AD), who was blinded to patients’ clinical and laboratory data.
US was considered positive when a homogeneous hypoechoic thickness >1.5 mm in AC and AS and >1mm in AA, in transverse and longitudinal view was observed. For the AT, the typical sign of halo (arterial wall swelling in transverse and longitudinal view) was considered as vasculitis. Relapse was defined as the reappearance of PMR clinical symptoms in addition to elevated ESR or CRP (ESR> 40 mm/h, CRP>10mg/lt) or persistent increased CRP/SR without any other explanation. All patients with positive US findings underwent a TAB.
Results
On a period of 14 months, 17 patients had been evaluated. All patients fulfilled the Bird’s classifications criteria for PMR and all the patients responded appropriately to CS treatment at baseline. None of the patients had GCA- related clinical symptoms either on baseline or during the relapse. No significant differences were observed between the two groups of patients (PMR + LVV and PMR – LVV) in age, diseases duration, initial CRP/SR levels and initial CS dose (prednisolon 15-25mg).
Seven out of 17 (41%) patients had ultrasonographic sign of vasculitis. All patients had affection of the AA (6 of them bilateral), 3 of the AS, 1 of the AT none of the AC. The patient with the positive US of the AT was the only who had a positive TAB.
Conclusion
In our study, the relationship between PMR relapse and concomitant “silence” LVV has been evaluated. More than one-third of PMR patients who relapsed had a co-existing LVV. Thus, we recommend the use of vascular US in all patients with PMR suffering a relapse to investigate the possible co-existence of LVV.
Disclosure:
S. Chrysidis,
None;
P. R. Lage-Hansen,
None;
A. P. Diamantopoulos,
None.
ACR Meeting Abstracts - https://acrabstracts.org/abstract/polymyalgia-rheumatica-relapse-and-silence-large-vessel-vasculitis-is-there-any-association/