Giant Cell Arteritis and Polymyalgia Rheumatica: an Update

González-Gay, Miguel Á.; Pina, Trinitario

doi:10.1007/s11926-014-0480-1

Cited by 63 publications

(60 citation statements)

References 41 publications

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“…Annual incidence rates for PMR in persons aged 50 years and older range from 113 per 100.000 in Norway to 41–84 cases per 100,000 population in the United Kingdom (UK), Denmark and Sweden and 59 cases per 100,000 in Olmsted County, Minnesota, USA. (4) The annual incidence of GCA is also higher in northern European countries in persons over the age of 50 (about 20 per 100,000 population) than in southern European countries (less than 12 cases per 100,000) or in Hispanic and Asian populations. (4, 19) In the US population, GCA is the most frequent primary vasculitis with an incidence of 18 cases per 100,000 Olmsted County residents.…”

Section: Discussionmentioning

confidence: 95%

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Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015

Crowson

Matteson

2017

Seminars in Arthritis and Rheumatism

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Objective There are no estimates of the prevalence of giant cell arteritis (GCA) or polymyalgia rheumatica (PMR) in a US population in the current millennium. The purpose of this study was to estimate the 2015 prevalence of GCA and PMR in a US population-based setting. Methods Cohorts of incident GCA in 1950–2009 and incident PMR in 1970–2014 were previously identified among residents of Olmsted County, Minnesota. Prevalence estimates were obtained from the age-, sex- and calendar year-specific incidence rates and adjusted to the US white 2010 population aged ≥50 years. Confidence intervals [CI] were computed using bootstrap sampling. Results There were 248 incident cases of GCA in 1950–2009 and 790 cases of PMR in 1970–2014. The overall age- and sex-adjusted prevalence rate of GCA on January 1, 2015 was 204 (95% CI: 161–254) per 100,000 population aged ≥50 years. GCA prevalence rate in women was 304 (95%CI: 229–375) and in men was 91 (95%CI: 46–156) per 100,000 population. The overall age and sex adjusted prevalence rate of PMR on January 1, 2015 was 701 (95%CI: 651–750) per 100,000 population. PMR prevalence rate in women was 870 (95%CI: 787–957) and in men was 508 (95%CI: 426–589) per 100,000 population. Conclusion Prevalence rates of GCA and PMR in 2015 are similar to previously published prevalence estimates in the late 1990s. The health burden of these diseases among older persons continues to be substantial and reflects the need for continued efforts to better manage it.

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Section: Discussionmentioning

confidence: 95%

“…(3) The highest incidence rates are seen in northern latitudes, in Scandinavian countries and people of northern European descent. (1, 4) Similar to PMR, GCA is more common in these populations in the Northern hemisphere. The lifetime risk for GCA is about 1.0% for women and 0.5% for men.…”

mentioning

confidence: 88%

Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015

Crowson

Matteson

2017

Seminars in Arthritis and Rheumatism

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“…PMR can be present in up to 50% of individuals with GCA and it may occur either before, during or after the manifestations of GCA appear, suggesting significant overlap between these two disease processes. 33 Therefore, our interpretation of any individual patient's diagnosis of GCA would be influenced by either pre-existing or concomitant diagnosis of PMR or might be validated by subsequent development of PMR.…”

Section: Clinical Presentation Of Giant Cell Arteritismentioning

confidence: 99%

The Role of Ultrasound Compared to Biopsy of Temporal Arteries in the Diagnosis and Treatment of Giant Cell Arteritis (TABUL): a diagnostic accuracy and cost-effectiveness study

Luqmani

Lee

Singh

et al. 2016

Health Technol Assess

366

404

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Background Giant cell arteritis (GCA) is a relatively common form of primary systemic vasculitis, which, if left untreated, can lead to permanent sight loss. We compared ultrasound as an alternative diagnostic test with temporal artery biopsy, which may be negative in 9–61% of true cases. Objective To compare the clinical effectiveness and cost-effectiveness of ultrasound with biopsy in diagnosing patients with suspected GCA. Design Prospective multicentre cohort study. Setting Secondary care. Participants A total of 381 patients referred with newly suspected GCA. Main outcome measures Sensitivity, specificity and cost-effectiveness of ultrasound compared with biopsy or ultrasound combined with biopsy for diagnosing GCA and interobserver reliability in interpreting scan or biopsy findings. Results We developed and implemented an ultrasound training programme for diagnosing suspected GCA. We recruited 430 patients with suspected GCA. We analysed 381 patients who underwent both ultrasound and biopsy within 10 days of starting treatment for suspected GCA and who attended a follow-up assessment (median age 71.1 years; 72% female). The sensitivity of biopsy was 39% [95% confidence interval (CI) 33% to 46%], which was significantly lower than previously reported and inferior to ultrasound (54%, 95% CI 48% to 60%); the specificity of biopsy (100%, 95% CI 97% to 100%) was superior to ultrasound (81%, 95% CI 73% to 88%). If we scanned all suspected patients and performed biopsies only on negative cases, sensitivity increased to 65% and specificity was maintained at 81%, reducing the need for biopsies by 43%. Strategies combining clinical judgement (clinician’s assessment at 2 weeks) with the tests showed sensitivity and specificity of 91% and 81%, respectively, for biopsy and 93% and 77%, respectively, for ultrasound; cost-effectiveness (incremental net monetary benefit) was £485 per patient in favour of ultrasound with both cost savings and a small health gain. Inter-rater analysis revealed moderate agreement among sonographers (intraclass correlation coefficient 0.61, 95% CI 0.48 to 0.75), similar to pathologists (0.62, 95% CI 0.49 to 0.76). Limitations There is no independent gold standard diagnosis for GCA. The reference diagnosis used to determine accuracy was based on classification criteria for GCA that include clinical features at presentation and biopsy results. Conclusion We have demonstrated the feasibility of providing training in ultrasound for the diagnosis of GCA. Our results indicate better sensitivity but poorer specificity of ultrasound compared with biopsy and suggest some scope for reducing the role of biopsy. The moderate interobserver agreement for both ultrasound and biopsy indicates scope for improving assessment and reporting of test results and challenges the assumption that a positive biopsy always represents GCA. Future work Further research should address the issue of an independent reference diagnosis, standards for interpreting and reporting test results and the evaluation of ultrasound training, and should also explore the acceptability of these new diagnostic strategies in GCA. Funding The National Institute for Health Research Health Technology Assessment programme.

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“…[1][2][3][4] The disease is predominant in the elderly, with an average age of onset of 70 years. The prevalence is estimated to be 1 in 500 individuals of >50 years of age.…”

Section: Introductionmentioning

confidence: 99%