Seronegative polyarthritis in giant cell arteritis

Area of Science:

• Rheumatology
• Immunology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large arteries.
• While GCA typically presents with constitutional symptoms and signs of cranial or large-vessel involvement, articular manifestations can occur.

Purpose of the Study:

• To investigate the occurrence and characteristics of persistent seronegative, symmetric polyarthritis in patients with biopsy-proven giant cell arteritis.
• To determine the temporal relationship between polyarthritis onset and GCA diagnosis.

Main Methods:

• Retrospective review of 520 patients with biopsy-proven giant cell arteritis.
• Analysis of patients who presented with persistent seronegative, symmetric polyarthritis.
• Assessment of clinical, radiographic, and synovial biopsy findings.

Main Results:

• Nineteen of 520 patients (3.6%) had persistent seronegative, symmetric polyarthritis.
• Polyarthritis onset preceded GCA diagnosis in 9 patients, was simultaneous in 3, and occurred within 3 years after GCA diagnosis in 7.
• Radiographic joint changes were observed in 10 patients, and synovial biopsy in one revealed giant cell infiltration.

Conclusions:

• Persistent seronegative symmetric polyarthritis, though uncommon, can be a presenting feature of giant cell arteritis.
• Clinicians should consider GCA in patients with this arthritis pattern, particularly those aged 50 and older, and actively seek other GCA symptoms.