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


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


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Diabetology Endocrinology Internal medicine
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