"Polymyalgia rheumatica"

Coronary ischaemia and occlusion in giant cell (temporal) arteritis

Reports of coronary artery involvement in giant cell (temporal) arteritis--polymyalgia rheumatica (GC(T)A--PMR) together with other large arteries arising from the aorta have been numerous over the past 40 years, but on this the specialist cardiac literature has been virtually silent. This article summarises that evidence, and records nine additional patients from a large group of cases with both GC(T)A--PMR and ischaemic heart disease (IHD) observed since a previous report in 1960. The case histories illustrate the benefit from corticosteroids and the hazards of non-diagnosis and premature cessation of such treatment. It seems that many patients with arteritic IHD (and claudication) are not being identified before or after death. Possible reasons for this oversight by clinicians and pathologists are offered, and suggestions are made with regard to points in history-taking and important physical signs which may help to alert the clinician. There is autopsy evidence from Malmö, Sweden, that the prevalence of GC(T)A--PMR is much higher than at present suspected on clinical grounds.

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.