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Temporal arteritis and polymyalgia rheumatica in north-eastern Spain: clinical spectrum and relationship over a 15
Javier Narváez1, Joan M Nolla-Solé, M T Clavaguera
1Department of Rheumatology, Hospital Príncipes de España, Ciutat Sanitaria y Universitaria de Bellvitge, Spain. 31577edd@comb.es
Objective:
To examine the clinical spectrum of polymyalgia rheumatica (PMR) and temporal arteritis (TA) and their relationship over a period of 15 years in an area of north-eastern Spain.
Methods:
We undertook a descriptive study of an unselected population of 163 patients with PMR and/or TA diagnosed from 1985 to 1999.
Results:
Of the 163 patients included, 90 had isolated PMR, 41 had PMR associated with TA, and 32 had isolated TA. The clinical spectrum of both conditions in our area was similar to that reported in other populations, including a marked female predominance. However, in our series, no patient developed permanent blindness or other major ischemic complications. PMR was observed in 56% of patients with TA. Conversely, 7% of patients originally suffering from PMR without clinical evidence of arteritis at presentation developed later symptoms of TA, and there were no predictive features for this. Interestingly, none of these patients suffered visual loss or other ischemic complications. The low risk of major complications in these cases does not support the need for systematic arterial biopsy in all patients with symptoms of PMR alone. On comparing patients with isolated TA with patients with PMR associated with TA, no differences were observed, thus discarding the possibility that the second constitutes a distinct and independent subgroup of TA. In contrast, when comparing patients with isolated PMR with patients with PMR associated with TA, we found significant differences between both the groups, with greater abnormality of clinical and laboratory markers of inflammation in patients with PMR associated with TA. These differences seem to reflect a greater degree of systemic inflammation linked to the presence of TA.
Conclusion:
In our area, TA appears nowadays as a benign disease which infrequently presents blindness or other major complications. Our experience confirms that even after a good clinical response with normalization of a high ESR in PMR, the patient is at risk for clinical development of TA. Finally, our study also shows that isolated TA and PMR associated with TA seem to be the same condition, different from isolated PMR.
Insights
Polymyalgia rheumatica (PMR) and temporal arteritis (TA) in Spain showed a similar clinical spectrum to other populations. TA appears benign, with infrequent major complications like blindness, but PMR patients remain at risk for TA development.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Epidemiology
Background:
- Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are inflammatory conditions affecting older adults.
- Understanding the relationship and clinical spectrum of PMR and TA is crucial for patient management and prognosis.
- Previous studies have reported varying rates of complications, particularly visual impairment, in TA patients.
Purpose of the Study:
- To investigate the clinical presentation and interrelationship of polymyalgia rheumatica (PMR) and temporal arteritis (TA).
- To analyze the incidence of major complications, such as blindness, in patients with PMR and/or TA over a 15-year period.
- To determine if PMR associated with TA represents a distinct clinical subgroup.
Main Methods:
- A descriptive, population-based study was conducted over 15 years (1985-1999).
- 163 unselected patients diagnosed with PMR and/or TA were included.
- Clinical data and outcomes were analyzed to compare patient groups and identify risk factors.
Main Results:
- The study included 90 cases of isolated PMR, 41 of PMR with TA, and 32 of isolated TA.
- The clinical spectrum was similar to other populations, with a female predominance. Notably, no permanent blindness or major ischemic complications were observed.
- PMR occurred in 56% of TA patients, and 7% of isolated PMR patients later developed TA without predictive features or visual loss.
Conclusions:
- Temporal arteritis in this Spanish region appears to be a relatively benign condition with a low risk of severe complications like blindness.
- Patients with polymyalgia rheumatica remain at risk for developing temporal arteritis, even after initial treatment response.
- Isolated TA and TA associated with PMR appear to be manifestations of the same underlying condition, distinct from isolated PMR.
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