Liver involvement in polymyalgia rheumatica and giant cell arteritis

Hysa, Elvis; Castagna, Alberto; Manzo, Ciro

doi:10.5114/reum.2020.101580

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…A high degree of suspicion led to prompt diagnosis and treatment of PMR-GCA in this patient. Cholestatic hepatic dysfunction is common in patients with PMR but disappears following glucocorticoid treatment [7]. It indicates a high risk of having overlapping GCA.…”

Section: Discussionmentioning

confidence: 99%

Polymyalgia rheumatica presenting as sternoclavicular arthritis: a case report

2022

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Background Polymyalgia rheumatica and giant cell arteritis are systemic inflammatory conditions of the elderly. Polymyalgia rheumatica classically presents as a bilateral proximal muscle pain and stiffness syndrome. Biceps tenosynovitis is the commonest pathology in polymyalgia rheumatica. However according to literature, erosive sternoclavicular arthritis is a rare association of polymyalgia rheumatica. Giant cell arteritis is an inflammatory granulomatous arteritis predominantly involving large cerebral arteries. Thus, its classic clinical presentation includes severe headache with scalp tenderness, jaw claudication, and sudden painless loss of vision. Urological manifestations (prostatic vasculitis and epididymo-orchitis) were seldom reported in giant cell arteritis. Case presentation A 53-year-old Sinhalese man presented with progressive right-sided shoulder joint pain and neck pain associated with constitutional symptoms and episodic generalized headache. Examination revealed restricted movements of the right shoulder joint with nontender pulsatile bilateral temporal arteries. Blood testing showed elevated erythrocyte sedimentation rate and C-reactive protein. Color Doppler ultrasound of the superficial temporal artery revealed “halo sign.” The temporal artery showed infiltration of mononuclear cells in the arterial media and adventitia. Computed tomography revealed right sternoclavicular arthritis with incidental finding of ureteric stricture. The patient was treated with high-dose oral prednisolone, and good clinical and biochemical response was observed during follow-up. Conclusion Polymyalgia rheumatica–giant cell arteritis may rarely present as erosive sternoclavicular arthritis as the initial manifestation, mimicking many rheumatological conditions. Urological involvement such as ureteric strictures may be rare associations of primary systemic vasculitis. A high degree of suspicion combined with targeted investigations would allow early identification the polymyalgia rheumatica–giant cell arteritis syndrome in the presence of atypical manifestations, leading to improved patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Polymyalgia rheumatica presenting as sternoclavicular arthritis: a case report

2022

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“…To conclude, behind an apparent simplicity, PMR syndrome hides a significant complexity, leaving several questions unanswered 22. As the notion of disease stratification within GPSD gains recognition, De Miguel et al ’s research suggests that PMR patients with subclinical GCA may experience a poorer prognosis compared with those without.…”

Section: What Are the Next Steps?mentioning

confidence: 99%

Polymyalgia rheumatica: crafting the future of a simple (but not easy!) clinical syndrome

Bond,

Dejaco

2023

Ann Rheum Dis

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“…Laboratory liver abnormalities are reported in PMR/GCA patients, especially with a cholestatic pattern, namely an increase of serum alkaline phosphatase (AP) due to the hepatic isoenzyme. Less frequent is a cytolytic pattern with elevation of alanine (ALT) and aspartate (AST) transaminases without raised AP and gamma-glutamyltranspeptidase (gGT) [16]. Some investigators hypothesized a possible immunological pathogenesis and, more specifically, reported an association with primary biliary cholangitis (PBC) [17], an autoimmune liver disease characterized by the damage of intrahepatic bile ducts.…”

Section: Introductionmentioning

confidence: 99%

Antimitochondrial Antibodies and Primary Biliary Cholangitis in Patients with Polymyalgia Rheumatica/Giant Cell Arteritis

Manzo

Maślińska

Castagna³

et al. 2021

Medicina

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Background and Objectives: Laboratory liver abnormalities can be observed in patients affected with polymyalgia rheumatica (PMR) and/or giant cell arteritis (GCA), especially with a cholestatic pattern. The first objective of our review article is to discuss the potential link between antimitochondrial antibodies (AMA) and/or primary biliary cholangitis (PBC) and PMR/GCA, according to the evidences of literature. The second objective is to discuss the association of PMR/GCA with the other rheumatic diseases having PBC as a common manifestation. Materials and Methods: A literature search was performed on PubMed and Medline (OVID interface) using these terms: polymyalgia rheumatica, giant cell arteritis, antimitochondrial antibodies, primary biliary cholangitis, primary Sjogren’s syndrome, systemic sclerosis, and systemic lupus erythematosus. The search was restricted to all studies and case reports published in any language. Reviews, conference abstracts, comments, and non-original articles were excluded; however, each review’s reference list was scanned for additional publications meeting this study’s aim. When papers reported data partially presented in previous articles, we referred to the most recent published data. Results and Conclusions: Our literature search highlighted that cases reporting an association between AMA, PBC and PMR/GCA were very uncommon; AMA antigenic specificity had never been detected and biopsy-proven PBC was reported only in one patient with PMR/GCA. Finally, the association of PMR/GCA with autoimmune rheumatic diseases in which PBC is relatively common was anecdotal.

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Liver involvement in polymyalgia rheumatica and giant cell arteritis

Cited by 6 publications

References 11 publications

Polymyalgia rheumatica presenting as sternoclavicular arthritis: a case report

Polymyalgia rheumatica presenting as sternoclavicular arthritis: a case report

Polymyalgia rheumatica: crafting the future of a simple (but not easy!) clinical syndrome

Antimitochondrial Antibodies and Primary Biliary Cholangitis in Patients with Polymyalgia Rheumatica/Giant Cell Arteritis

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