Education And Debate


BMJ 1995; 310 doi: (Published 22 April 1995) Cite this as: BMJ 1995;310:1057
  1. Gillian Pountain,
  2. Brian Hazleman

    In recent years giant cell arteritis and polymyalgia rheumatica have increasingly been considered as closely related conditions. The two syndromes form a spectrum of disease and affect the same types of patient. The conditions may occur independently or may occur in the same patient, either together or separated in time.

    Polymyalgia rheumatica is a clinical syndrome of middle aged and elderly patients and is characterised by:

    • Pain and stiffness in the neck and the shoulder and pelvic girdles

    • Systemic features such as low grade fever, fatigue, and weight loss

    • An increased erythrocyte sedimentation rate

    • A dramatic response to small doses of corticosteroids.

    Swollen temporal artery of patient with giant cell arteritis.


    Aetiology of polymyalgia rheumatica and giant cell arteritis

    • There is often a distinct prodromal event resembling influenza, but results of viral studies are negative

    • Lymphocytes in arteritic lesions express the T cell phenotype, and the CD4 subset predominates

    • Frequency of HLA-DR4 is increased

    Polymyalgia rheumatica—At present it is impossible to define the underlying pathological abnormality in polymyalgia rheumatica, and several different mechanisms may be responsible for a largely similar pattern of pain.

    Giant cell arteritis is limited to vessels with an internal elastic component. Both humoral and cellular immunological mechanisms have been implicated in its development, and the latter seem to be more important.

    Giant cell arteritis affects white people almost exclusively, but it has been reported in black Americans. In all studies both conditions are very rare under the age of 50 years. Reports from Olmsted County, Minnesota, and Gothenburg, Sweden, have shown that the incidence is increasing in women but not in men. About half of patients with giant cell arteritis have symptoms of polymyalgia rheumatica, whereas 15-50% of patients with polymyalgia rheumatica have giant cell arteritis. Problems with case definition and ascertainment complicate epidemiological observations.

    Epidemiology of giant cell arteritis

    • Peak incidence at ages 60-75

    • Sex distribution of 3 …

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