Polymyalgia rheumatica and giant cell arteritis

Author: Dasgupta/Bhaskar/Dejaco/Christian Published year: 2016 Downloads: 8

Brief content

The twin topics of this book, polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), account for the commonest causes for long-term steroid treatment in the community. PMR is the rheumatic disease subject to the widest variations of clinical practice due to the considerable uncertainty related to diagnosis and outcomes. GCA is a critically ischaemic disease that presents, like PMR, with a broad spectrum of clinical manifestations often complicated by acute ischaemic events including permanent visual loss or stroke.

Early accurate recognition, diagnosis, and adequate treatment of the conditions are thus imperative to prevent loss of independence and to maintain quality of life. Unfortunately, these conditions, exclusively occurring in older people, have thus far been deemed ‘treatable’ unimportant disorders due to a traditionally sanctioned notion of ‘unique steroid responsiveness’ despite the absence of any supportive credible evidence for this view. This preconception often becomes a pitfall due to the initial subjective improvement seen in many serious and non-serious conditions in response to high-dose steroid therapy.

Corticosteroids remain the cornerstone of the treatment of PMR and GCA; treatment-related complications are thus a significant burden to patients. The value of steroid-sparing agents is unclear and is being addressed by emerging current and future research. There is an overlap between PMR, GCA, and large-vessel vasculitis (presciently termed as ‘polymyalgia arteritica’ by Hamrin 60 years ago), and many inflammatory arthritides, connective tissue diseases, and vasculitides have a polymyalgic onset in older people.

This makes imaging, with ultrasound and other modalities such as magnetic resonance imaging and positron emission tomography-computed tomography, integral to the management of these conditions. This pocketbook on PMR and GCA is intended to provide quick and practically relevant information on several aspects of the diseases, particularly on diagnosis and management. Ultimately, the aim of this book is to improve patient care.

The intended audience is the rheumatologist, general practitioner, and other professionals caring for patients with PMR and GCA.

There have been recent advances in these areas. The provisional European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) PMR classification criteria have been published, EULAR/ACR PMR guidelines are awaiting publication, and national international guidelines are being disseminated for GCA. The fast-track GCA pathway, shown to reduce sight loss, is gaining ground as the standard of care. PMRGCAuk, a charity designated exclusively for these conditions, is working tirelessly to increase public and professional awareness and offer support to patients.

This pocketbook, written by international experts, highlights current concepts of pathogenesis as well as recent advances in diagnostic and therapeutic approaches. Ongoing research aims at the identification of new biomarkers and corticosteroid-sparing medications, which should improve the long-term outcome of PMR and GCA patients. Each chapter is complemented with ‘key points’ boxes, highlighting the most relevant information for clinical practice. Practical flowcharts (e.g. on diagnostic work-up and treatment) are also provided.

We are most grateful to Oxford University Press and our many international colleagues who have worked tirelessly to bring this unique publication effort to fruition.