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[A case of temporal arteritis associated with polymyalgia rheumatica and subclinical Sjögren's syndrome]
K Kohriyama1, A Kohno, S Arimori
1Department of Internal Medicine, Kobe West Municipal Hospital.
Abstract:
A case of temporal arteritis (TA) associated with polymyalgia rheumatica (PMR) and subclinical Sjögren's syndrome (sub SjS) was presented in this paper. A 76 year-old-male was admitted with headache, fever and weight loss in April 1987. Myalgia of upper extremities and of thighs developed during the past two months before admission. He also had noticed bilateral wrist pain. Physical examination revealed slight cord-like thickening of left temporal artery with tenderness. Cerebral angiography disclosed narrowing of frontal and parietal branches of left temporal artery. Temporal artery biopsy was consistent with TA. Diagnosis of PMR was made by Bird's diagnostic criteria. Although sicca symptoms were not seen, sialography revealed moderate sialectasis. Pathological finding of salivary gland was compatible with sub SjS. Possibility of occult lymphoma was eliminated by CT scanning or myelogram. Laboratory evaluation disclosed slight anemia, leukocytosis and thrombocytosis. Blood chemistry showed no abnormal finding except for hyperfibrinogenemia. Serological studies indicated positive C-reactive protein and slight elevation of alpha 2 and beta globulin fractions of serum protein. Either rheumatoid factors, antinuclear antibodies, anti-smooth muscle antibodies, cryoglobulin or circulating immune complexes were not detected. The HLA-B8 and DR3, frequently detected in TA and SjS, were not identified. Tuberculin test was negative. These results suggested that immunological aberration not caused by genetic factors but by senescence would induce presence of TA associated with both PMR and sub SjS.
Insights
This case study presents temporal arteritis (TA) in a 76-year-old male, co-occurring with polymyalgia rheumatica (PMR) and subclinical Sjögren's syndrome (sub SjS). Findings suggest senescence-induced immune changes may link these conditions.
Area of Science:
- Rheumatology
- Immunology
- Geriatrics
Background:
- Temporal arteritis (TA) and polymyalgia rheumatica (PMR) are common in the elderly.
- Subclinical Sjögren's syndrome (sub SjS) can present without typical sicca symptoms.
- The co-occurrence of TA, PMR, and sub SjS is rare and its etiology is not fully understood.
Observation:
- A 76-year-old male presented with headache, fever, weight loss, myalgia, and wrist pain.
- Physical exam revealed temporal artery thickening and tenderness; angiography showed arterial narrowing.
- Temporal artery biopsy confirmed TA; diagnostic criteria met for PMR.
- Sialography and salivary gland biopsy indicated sub SjS despite absence of sicca symptoms.
Findings:
- Laboratory results showed anemia, leukocytosis, thrombocytosis, and hyperfibrinogenemia.
- Elevated C-reactive protein and altered serum protein fractions were noted.
- Absence of common autoimmune markers (rheumatoid factor, ANA, etc.) and specific HLA types (B8, DR3).
- CT and myelogram ruled out occult lymphoma.
Implications:
- The case suggests that age-related immunological changes (senescence) rather than genetic predisposition may contribute to the development of TA, PMR, and sub SjS.
- This highlights the importance of considering multiple autoimmune conditions in elderly patients with overlapping symptoms.
- Further research into age-related immune dysregulation is warranted to understand such complex presentations.