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11/1/06 Giant cell arteritis and polymyalgia rheumaticaSummary Findings - Some clinical aspects of GCA and PMR were reviewed by Gonzalez-Gay et al of Lugo, Spain. GCA is manifested mainly by its involvement of cranial arteritis, particularly the external carotid branches. Jaw claudication, head pain, local tenderness, particularly over the temporal arteries, and sometimes visual loss due to retinal artery occlusion are the main symptoms of GCA. PMR is characterized clinically by aching pain and morning stiffness involving the neck, shoulder and hip girdles. In both GCA and PMR there is prominent increase in the ESR and C-reactive protein levels. A temporal artery biopsy (sometimes needed bilaterally) is the most definitive diagnostic test in GCA, particularly when there is tenderness in that temporal region. There is no single diagnostic test for PMR. Corticosteroids (CS) are still the major treatment in both PMR and GCA with prompt symptomatic response of PMR to about 20 mg prednisone/day. Higher initial CS doses (40-60 mg/day) are often needed to control GCA. The dose of CS are reduced gradually when the symptoms abate and the ESR decreases towards normal However, relapses are common when the CS treatment is withdrawn completely, necessitating resumption and then long-term treatment with low dosage CS. Therefore, other agents including some newer biologic agents, are tried as additive therapy as a CS dose sparing approach. Reference Editor's Comments
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