Polymyalgia rheumatica: 125 years of progress?

FRI0200 TIME TO FLARE IN GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA AND REVIEW OF THE LITERATURE

AB0382 DOES THE ULTRASOUND IMAGE OF THE LARGE VESSEL WALLS DIFFER IN THE SUBTYPES OF GCA AND PMR OR THERE IS A SYSTEMIC SUBCLINICAL COMMON INFLAMMATION?

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder in elderly people. It is frequently associated with giant-cell arteritis (GCA), although it is still debated if they are the same disease or two distinct pathologies. The etiology of PMR remains challenging, although current knowledge supports the role of both genetic and environmental factors. Among these, there is evidence that infectious agents could trigger the disease's onset in some cases. We describe the peculiar case where PMR occurred in two Italian married and cohabiting couples and provide a review of the literature for similar cases. This is the first reported occurrence of PMR in two conjugal pairs in Italy. Moreover, in the second case, the wife presented PMR associated with GCA. To date, seven cases of PMR and two of GCA in married couples are described in the literature. The occurrence of PMR in both a husband and a wife supports the pathogenetic role of an environmental factor.

AB0465 ANALYSIS OF VASCULITIS PATTERNS IN PATIENTS WITH GIANT CELL ARTERITIS COMPARED TO PATIENTS WITH GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA

To elucidate epidemiologic and clinical manifestations of Japanese patients with giant cell arteritis (GCA), the first nationwide survey for GCA was conducted in 1998 in Japan. The first questionnaire on GCA for patients treated in 1997 was sent to 10,717 medical departments in Japan. A total of 177 patients were reported. Among the 177 patients, 66 GCA patients with detailed clinical and epidemiologic features on second survey were analyzed. Prevalence in patients 50 years of age and older in 1997 was 1.47 per 100,000 population in Japan. The average age at onset was 71.5 years old. The male:female ratio was 1:1.7. The association with permanent and complete visual loss (6.5%), jaw claudication (15.2%), and polymyalgia rheumatica (PMR) (30.3%) were low in frequency compared with those reported from other countries. All patients were treated with corticosteroids. Only 3 (4.5%) patients were reported as deceased due to other causes. The prevalence of GCA in Japan was revealed to be extremely low compared with other countries. Clinical findings of permanent and complete visual loss, jaw claudication, and PMR were infrequent among Japanese patients with GCA.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) as 2 types of autoimmune diseases are frequently concomitant, and Mendelian randomization (MR) was applied in this study to assess the causal relationship between them. In this study, single-nucleotide polymorphism (SNP) was used as the instrumental variable for Mendelian analysis, and the SNP data of GCA and PMR were obtained from the FinnGen Biobank databases. SNPs are significantly correlated with GCA and PMR and were screened based on preset thresholds. Inverse variance weighted analysis was used as the main analysis, supplemented with MR-Egger and weighted median. The evidence of the impact of GCA on PMR risk was found in inverse variance weighted results (odds ratio, 1.22 [95% confidence interval, 1.11-1.34]; P < .01), and the evidence of the impact of PMR on GCA risk has also been found (odds ratio, 1.58 [95% confidence interval, 1.28-1.96]; P < .01). Finally, the stability and reliability of the results were tested using the retention method, heterogeneity test, and horizontal gene pleiotropy test. MR analysis indicates that GCA increases the risk of PMR and PMR is an important risk factor for GCA, with a causal relationship. The potential value of reasonable management of PMR in patients with GCA has received high attention. In addition, novel GCA therapeutics may be indicated for PMR, and it is a potential for further investigation.

AB0439 Contribution of anti-ferritin antibodies to the diagnosis of giant cell arteritis

76-Year-Old Man With New Bilateral Shoulder Pain

Objective. To describe the maintenance dose and annual cessation rate of oral corticosteroids in relation to the starting dose in patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA). Methods. A prospective two-years observational study of 273 patients with PMR and TA followed by rheumatologists. Results. Mean daily maintenance dose of prednisolone during the first and second year was 5.7 mg and 4.3 mg for PMR, 6.6 mg and 4.1 mg for TA, and 8.3 mg and 4.7 mg for PMR with TA. There was a strong association between the initial dose and maintenance dose. The rate of steroid cessation after two years in PMR was 24%, in TA 16%, and in PMR with TA 5%. Conclusion. Low initial dose of prednisolone is associated with low maintenance dose. This is important as the majority of patients with PMR and TA will be treated for more than two years.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders predominantly affecting older adults. PMR is primarily characterized by proximal muscle pain and systemic inflammation, while GCA involves large-vessel inflammation, posing risks of vision loss and stroke. Due to overlapping clinical features and age-related prevalence, diagnosing these conditions remains challenging. While PMR is largely diagnosed based on clinical symptoms and laboratory markers, GCA often requires histopathological confirmation via temporal artery biopsy (TAB). This study aims to assess the clinical presentation, diagnostic approaches, and treatment outcomes of PMR and GCA in geriatric patients, emphasizing the role of clinical versus laboratory and histopathological diagnosis. A cross-sectional study was conducted at Khyber Teaching Hospital, Peshawar, Pakistan, from September 2023 to September 2024, involving 118 patients aged 50 years or older diagnosed with PMR and/or GCA. Data were collected through patient interviews, medical records, and diagnostic reports. Statistical analyses were performed to evaluate clinical characteristics, laboratory markers, and treatment responses. The mean age of participants was 68.5 ± 7.4 years, with 65% female. PMR diagnosis was based on clinical symptoms, supported by laboratory markers such as elevated CRP (85%) and ESR (90%). GCA was clinically suspected in 38 patients, with 76% confirmed through TAB. Additionally, 67% of GCA patients exhibited the "halo sign" on vascular ultrasound, while 12% required magnetic resonance angiography for further evaluation. Glucocorticoid therapy was initiated in all cases, leading to clinical remission in 84% of patients. However, 28% developed hyperglycemia, and 14% experienced osteoporosis as treatment-related complications. Delayed glucocorticoid initiation caused a significantly higher relapse rate (p = 0.04). Glucocorticoid therapy remains effective in most cases, though adverse effects necessitate careful monitoring. Tocilizumab was required in 18% of patients due to glucocorticoid resistance or intolerance, but it causedhigher relapse rates and metabolic complications. The findings emphasize the need for steroid-sparing therapies and personalized treatment approaches to improve long-term disease control. Future research should explore newer biologic treatments, optimize imaging strategies, and address resource limitations to enhance early detection and management outcomes in elderly patients.

Giant cell arteritis (GCA) is a form a large- to medium-vessel vasculitis that involves the aorta and its branches. Polymyalgia rheumatica (PMR), a syndrome of muscle pain and stiffness in the neck, shoulders, and hips, often occurs with GCA but can occur independently. GCA predominantly affects the second- to fifth-order aortic branches, often in the extracranial arteries of the head. The mean age at diagnosis of GCA is approximately 72. The diagnosis of GCA is made usually by biopsy of the temporal artery. GCA associated with granulomatous inflammation within the blood vessel wall, but granulomatous changes are not always evident early in the disease. Giant cells occur in a slight majority of cases of positive temporal artery biopsies. Estimates of the frequency of giant cells in temporal artery biopsy tissues are on the order of 50–80%. In GCA, clinical symptoms of local vascular inflam-mation and vascular insufficiency are usually accompanied or preceded by a systemic inflammatory process. Visual loss is the most feared complication of GCA. Visual loss may occur through the syndrome of anterior ischemic optic neuropathy, caused by narrowing of the posterior ciliary artery, as well as through other arterial insufficiency syndromes. Glucocorticoids are the cornerstone of treatment for GCA and PMR. PMR occurring in the absence of GCA requires a lower dose of prednisone for disease control.

Background18 F-Fluorodeoxyglucose positron emission tomography (PET) reveals the presence of large vessel vasculitis (LVV) in 30%–40% of patients with apparently isolated polymyalgia rheumatica (PMR), in 70%–80% of patient with giant...

Background:About half of patients with giant cell arteritis (GCA) experience disease relapse. However, the relationship between symptoms at diagnosis and at time of relapse remains unknown.Objectives:To compare the symptoms at...

POS0808 CHARACTERISTICS OF GIANT CELL ARTERITIS FLARES AFTER SUCCESSFUL TREATMENT WITH TOCILIZUMAB: RESULTS FROM THE LONG-TERM EXTENSION OF A RANDOMIZED CONTROLLED PHASE 3 TRIAL

Arthritis Research & Th erapy by Kreiner and Galbo [1] that reported a very modest benefi t of etanercept monotherapy in polymyalgia rheumatica (PMR).Th ere is some evidence that TNFα can be found in the lesions of giant cell arteritis (GCA) [2].However, two previous randomised controlled trials [3,4] showed no benefi t of TNFα inhibition in the treatment of PMR/GCA.We report for the fi rst time the development of PMR and GCA in two patients undergoing treatment with anti-TNFα drugs.Th is suggests that the underlying