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Polymyalgia Rheumatica and Giant Cell Arteritis

Polymyalgia rheumatica and giant cell arteritis represent varying manifestations of one disease: Both affect the same population (patients over the age of 50), show preference for the same HLA haplotypes, and show similar patterns of cytokines in blood.

Polymyalgia rheumatica is a clinical diagnosis based on pain and stiffness of the shoulder and pelvic girdle area, frequently in association with fever, malaise, and weight loss. Anemia and a markedly elevated sedimentation rate are almost always present. Because of the shoulder and pelvic area stiffness and pain, patients have trouble combing their hair, The differential diagnosis of malaise, anemia, and a markedly elevated sedimentation rate includes multiple myeloma, other malignant disorders, and chronic infections such as bacterial.

Giant cell arteritis is a systemic panarteritis affecting medium-sized and large vessels in patients over the age of 50. The condition is also called temporal arteritis, since that artery is frequently involved, as are other extracranial branches of the carotid artery. About 50% of patients with giant cell arteritis also have polymyalgia rheumatica. The classic symptoms suggesting that a patient has arteritis are headache, scalp tenderness, visual symptoms, jaw claudication, or throat pain.

Blindness results from occlusive arteritis of the posterior ciliary branch of the ophthalmic artery. The ischemic optic neuropathy of giant cell arteritis may produce no funduscopic findings for the first 24-48 hours after the onset of blindness. The murmur of aortic regurgitation or bruits heard near the clavicle identify the occasional patient polymyalgia rheumatica.

The main reason to diagnose and treat giant cell arteritis is to prevent blindness. Once blindness develops, it is usually permanent. Therefore, when a patient has symptoms and findings suggestive of temporal arteritis, therapy with prednisone, 60 mg daily, is initiated immediately, and temporal artery biopsy is promptly obtained.
In adjusting the dosage of steroid, the erythrocyte sedimentation rate is a useful but not absolute guide to disease activity. Blindness rarely occurs when the ESR has reached the normal range. The drug may be slowly tapered when disease activity ceases, although the giant cell arteritis.