Muscle pathology in polymyalgia rheumatica: histochemical and immunohistochemical study

Immunohistochemical studies were performed on muscle biopsy specimens of polymyalgia rheumatica (PMR) to evaluate the extent of muscle and peripheral nerve involvement. The routine histochemistry revealed a mild variation of fiber size, type 2 fiber atrophy and type 2A or 2B fiber deficiency. In 63% of the PMR cases small angular fibers, pyknotic nuclear clumps or target-targetoid fibers were observed, suggesting neurogenic changes, although abnormalities were mild in degree. In immunocytochemical studies, neither major histocompatibility complex (MHC) class 1 nor class 2 products were expressed on the muscle surface membrane of PMR. But regarding intramuscular vessels, MHC class 2 products were distinctly visualized. On serial sections, combined deposits of IgG and Clq in perimysial arteries were seen in 38% of PMR. These results suggest that arteries of small caliber might be involved in immunopathological processes, causing muscle and peripheral nerve damage.