Polymyalgia rheumatica

The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970

Giant cell arteritis and polymyalgia rheumatica were described separately more than 100 years ago. However, the original reports of both conditions were neglected for many years. After the article by Horton et al on giant cell arteritis in the 1930s and studies published by others in the 1940s, giant cell arteritis began to be recognized as a specific disease. In the 1950s and 1960s, many of the numerous presentations and complications of giant cell arteritis were recorded. In a somewhat similar fashion, physicians became cognizant of polymyalgia rheumatica only after several independent descriptions in the 1940s and 1950s. The rapid response of both syndromes to glucocorticoid therapy was discovered shortly after cortisone's effect on rheumatoid arthritis was described. The origin of the proximal aching and stiffness in polymyalgia rheumatica was more difficult to understand. The relatively minor findings in the joints on physical examination seemed insufficient to account for the severe discomfort. As the link between polymyalgia rheumatica and giant cell arteritis became apparent, some thought the aching in polymyalgia rheumatica was related to vasculitis. The debate about whether proximal synovitis or vasculitis was the cause of the symptoms continued after 1970. Although the reason these 2 conditions were associated was not considered by 1970, the establishment of the syndromes as clinically linked entities provided the groundwork for further progress in the next decades.

Giant cell (temporal) arteritis

Headache is the most frequent symptom for which a patient with giant cell arteritis (GCA) presents to a neurologist. Amaurosis fugax and ischemic optic neuropathy are well recognized complications. Less commonly recognized neurologic complications include transient ischemic attacks, cerebral infarctions, acute confusional states, multi-infarct dementia, ischemic cervical myelopathy, and ischemic mononeuropathies. Because patients with GCA generally respond well to corticosteroid therapy, prompt diagnosis can minimize neurologic damage.

Steroid-responsive electromyographic abnormalities in polymyalgia rheumatica

Prior to definitive diagnosis, electrodiagnostic studies are often requested in patients with polymyalgia rheumatica to evaluate complaints of muscle aching, tenderness, and weakness. These studies are generally normal, although rare reports of electromyographic abnormalities in polymyalgia rheumatica exist. Two patients with polymyalgia rheumatica and electrodiagnostic findings consistent with diffuse denervation are described. Following steroid treatment, both patients experienced impressive clinical and electromyographic improvement. To explain this improvement, we hypothesize a steroid-responsive microvascular arteritis resulting in ischemic damage to axons of motor nerve terminal branches.

The epidemiology of giant cell arteritis. Report of a ten-year study in Shelby County, Tennessee

We have studied the epidemiology of giant cell arteritis (GCA) in an urban population in south central United States. The incidence of GCA in Shelby County, Tennessee for the years 1971 through 1980 was determined for the total population and for age-, sex-, and race-specific groups. Over this period 26 cases were identified. The average annual incidence was 0.35/100,000. This was increased to 1.58/100,000 for those over the age of 50. The incidence was 7 times greater in whites than in blacks and 7 times greater in females than in males. Clinical and laboratory features of the patients were reviewed and found to be similar to those in other populations. GCA is considerably less frequent in Shelby County, Tennessee than in other areas where similar epidemiologic studies have been performed. This difference can be accounted for only in part by racial distributions. Similar studies in southern geographic areas are needed to place our findings in perspective and point to specific factors which may have etiologic significance in GCA.

Unusual electromyographic findings in a patient with polymyalgia rheumatica

A case of polymyalgia rheumatica (PMR) with biopsy-proven giant cell arteritis (GCA) is described in which there were marked abnormalities noted on electromyography (EMG). Spike potentials, positive waves, and fibrillation potentials were seen in the proximal musculature of the upper and lower extremities as well as in the erector spinae muscles. Investigation failed to reveal abnormalities in either creatinine phosphokinase (CPK), aldolase, or muscle obtained at biopsy. The presence of these EMG findings in the PMR-GCA syndrome is unusual. Response to therapy with systemic corticosteroids and normalization of the EMG are documented.