RESUMO
Giant cell arteritis is an autoimmune disease that affects medium and large caliber vessels, creating deposits of inflammatory clusters on the arterial wall. It is the most common form of large vessel vasculitis, but given the variability of biopsy efficiency and of other diagnostic strategies employed, the diagnosis of this disease is challenging. We report the case of a 69-year-old female patient who presented with neurological deficit and increased bilateral sensation in the temporal region associated with excruciating headache. Workup revealed calcification of the superficial temporal, vertebral and ophthalmic arteries, as well as suggestive findings on Doppler ultrasound such as the halo sign, pointing to superficial temporal arteritis though not excluding the possibility of those calcifications being consistent with atherosclerosis in a patient with advanced chronic renal disease, which has been reported as giving rise to false-positive results. Knowledge of the main differences between the 2 diagnoses is important, given the wide range of diagnostic imaging possibilities which can avoid the need for biopsy.
RESUMO
OBJECTIVE: Polymyalgia rheumatica (PMR) is the most common inflammatory disease in patients over 50 years. Information about the disease in Latin America (LATAM) is scarce. We aimed to evaluate a group of Colombian patients with PMR and to conduct a systematic review of PMR in LATAM. METHODS: A multicentric retrospective study was performed. Medical records of 256 PMR patients were evaluated. Patients were divided into two groups, those fulfilling the 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for PMR and those who did not (i.e., clinical diagnosis). A systematic literature review and meta regression was performed comparing Colombian vs LATAM patients. RESULTS: From 256 patients, 145 (56.6%) fulfilled the 2012 EULAR/ACR criteria, and 111 (43.3%) were classified by clinical diagnosis. Inflammatory bilateral shoulder pain, pelvic girdle aching, morning stiffness >45 min, elevated erythrocyte sedimentation rate (ESR), and C-reactive protein (CPR), and Methotrexate (MTX) prescription were more common in the 2012 EULAR/ACR group. None of the included patients presented overt polyautoimmunity (PolyA), whereas up to 24% exhibited latent PolyA. In addition, these patients showed high frequency of malignancy (7.59%). In the meta regression analysis, Colombian patients exhibited lower ESR levels, and were less likely to develop giant cell arteritis (GCA) as compared to the rest of LATAM data. CONCLUSION: Patients with PMR in LATAM exhibit similar phenotypes from other cohorts worldwide. Malignancy, GCA and latent PolyA should be considered in the routine clinical follow-up of patients with PMR.