Polymyalgia rheumatica. Temporal arteritis

Polymyalgia rheumatica is a disease characterized by pain and stiffness in the shoulder girdle (shoulders) and pelvic girdle (hips). It appears mainly from the 5th decade of life and affects more women.

The prevalence is 1-3.5% in individuals over 65 years of age.

Temporal arteritis (cranial or Horton arteritis) is a vasculitis that affects the temporal artery that is located in the left and right frontal area of ​​the head. Its maximum incidence is from the 8th decade of life with a double prevalence in women compared to men. Approximately 50% have associated polymyalgia rheumatica.

The prevalence is 1% or in elderly individuals.

How is it produced?

The cause is unknown. There seems to be a genetic predisposition to suffer from the disease. The good response to corticosteroids suggests the relationship of autoimmune processes with these diseases.

Symptoms

Polymyalgia rheumatica is characterized by localized pain in the shoulder and pelvic girdle that increases with mobilization and is accompanied by morning stiffness. The pain progressively increases until it can be disabling. Synovitis may also appear, and general symptoms such as fever, anorexia, weight loss, and fatigue.

It can appear alone or associated with temporal arteritis in 40-60% of cases.

Temporal arteritis manifests clinically with headache in 60-90% of cases. It is a headache with characteristics different from the usual ones and of recent appearance. It is usually accompanied by pain in the scalp and jaw claudication (loss of strength in the jaw joint favoring the jaw dropping), a sign that supports the diagnosis. Palpation of the temporal arteries shows a hardening and diminution or absence of their pulses.

The most serious complication of temporal arteritis is the loss of vision in one or both eyes, all or one visual field. It is usually of sudden onset and previously there have been eye discomforts.

It also presents general symptoms as in the case of polymyalgia rheumatica.

Diagnosis

The diagnostic criteria for polymyalgia rheumatica are:

• Symmetrical pain and / or stiffness in shoulders
• Symptoms <2 weeks
• Morning stiffness lasting more than 1 hour
• ESR greater than 40 mm / h
• Age over 65 years
• Depression or weight loss
• pain on palpation of the proximal arm muscles
• The diagnosis is established with a minimum of three criteria.

The definitive diagnosis of temporal arteritis is made by biopsy of the superficial temporal artery. It is a simple procedure in which a 3 cm segment must be removed for study. However, there are some clinical diagnostic criteria for temporal arteritis, which are:

• Age over 55 years
• Clinical improvement in the first 48 hours after starting treatment with corticosteroids
• Duration of symptoms greater than 3 weeks
• Positive temporal artery biopsy
• Polymyalgia rheumatica
• Mandibular claudication
• Abnormalities on physical examination of the temporal artery
• Systemic manifestations (fever, fatigue, anorexia, weight loss ...)
• Headache of recent onset or of different characteristics than usual
• Visual disturbances

The diagnosis is established with the presence of the first three criteria plus another three of those between points 5 and 10. The absence of lesions from the biopsy does not exclude the diagnosis.

The prognosis of temporal arteritis is good, only a small group of patients present serious complications such as ruptured aortic aneurysm, stroke, or myocardial infarction.

Treatment

The use of glucocorticoids is the choice. They produce a rapid and complete remission of symptoms, in addition to preventing serious complications. The duration of treatment is at least 18-24 months, although some patients must continue treatment due to relapses. In some cases the treatment is indefinitely with low doses of prednisone.

Regular exercise is important to keep your joints and muscles flexible.