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An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Predictors of giant cell arteritis in patients with polymyalgia rheumatica in southern Sweden-a retrospective study
Charlotta Fors1,2, Ulf Bergström1, Aladdin J Mohammad3,4,5
1Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
Objective:
To identify predictors of GCA in patients with PMR.
Methods:
Patients with PMR were identified among participants in two population-based health surveys. Those with a registered diagnosis indicating PMR in national and regional registers (the latter including primary care) were included. Medical records from hospitals and primary care were systematically reviewed. PMR diagnoses were verified by a rheumatologist in an independent review. Potential predictors were examined using logistic regression analysis.
Results:
Of 1508 medical records, 1030 had sufficient data available. PMR diagnoses were verified in 626 patients (61%). GCA was diagnosed within 1 month of PMR diagnosis in 37 patients and at a later time point in 20 patients. Female patients were more likely to develop GCA at PMR diagnosis or later [odds ratio (OR) 2.38 (95% CI 1.23, 4.61)]. Higher ESR and CRP levels were also associated with GCA. A lower risk for GCA was seen in those presenting with pain/stiffness in the hip [OR 0.51 (95% CI 0.28, 0.92)].
Conclusion:
In this large cohort of patients with verified PMR, GCA was diagnosed in a limited subset (9%) and was more common in females. A lower risk for GCA was seen in patients with pain/stiffness in the hip at onset of PMR, suggesting that prominent musculoskeletal symptoms and cranial arteritis represent different parts of the GCA-PMR spectrum.
Insights
Giant Cell Arteritis (GCA) occurred in 9% of patients with Polymyalgia Rheumatica (PMR). Female patients and elevated inflammatory markers like ESR and CRP predicted GCA, while hip pain at PMR onset suggested lower GCA risk.
Area of Science:
- Rheumatology
- Internal Medicine
- Epidemiology
Background:
- Polymyalgia Rheumatica (PMR) and Giant Cell Arteritis (GCA) are common vasculitides in older adults.
- Understanding predictors of GCA in PMR patients is crucial for timely diagnosis and treatment.
- PMR and GCA share overlapping clinical features, complicating differential diagnosis.
Purpose of the Study:
- To identify predictors of GCA development in patients diagnosed with PMR.
- To investigate demographic and clinical factors associated with GCA in a PMR cohort.
Main Methods:
- A cohort of patients with PMR was identified from population-based health surveys and national registers.
- Medical records were reviewed, and PMR diagnoses were verified by a rheumatologist.
- Logistic regression analysis was used to examine potential predictors of GCA.
Main Results:
- Of 1030 patients with verified PMR, 626 had sufficient data for analysis.
- GCA was diagnosed in 57 patients (9%), with 37 diagnosed within one month of PMR diagnosis.
- Female sex (OR 2.38), higher ESR and CRP levels were associated with increased GCA risk, while hip pain/stiffness at PMR onset was associated with lower GCA risk (OR 0.51).
Conclusions:
- GCA is diagnosed in a minority of PMR patients, with females being more susceptible.
- Hip pain at PMR onset may indicate a distinct clinical phenotype within the GCA-PMR spectrum.
- These findings highlight the importance of considering GCA in PMR patients, particularly in females with elevated inflammatory markers.
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