Giant-cell arteritis and polymyalgia rheumatica
CM Weyand, JJ Goronzy - New England Journal of Medicine, 2014 - Mass Medical Soc
CM Weyand, JJ Goronzy
New England Journal of Medicine, 2014•Mass Medical SocKey Clinical Points Giant-Cell Arteritis and Polymyalgia Rheumatica The immune-mediated
diseases giant-cell arteritis and polymyalgia rheumatica occur in patients 50 years of age or
older and are now recognized as chronic conditions. The diagnosis of giant-cell arteritis
should be confirmed on the basis of histologic findings when possible. Glucocorticoids are
the standard therapy for both giant-cell arteritis and polymyalgia rheumatica, with higher
doses used for giant-cell arteritis. Disease flares in patients with giant-cell arteritis and …
diseases giant-cell arteritis and polymyalgia rheumatica occur in patients 50 years of age or
older and are now recognized as chronic conditions. The diagnosis of giant-cell arteritis
should be confirmed on the basis of histologic findings when possible. Glucocorticoids are
the standard therapy for both giant-cell arteritis and polymyalgia rheumatica, with higher
doses used for giant-cell arteritis. Disease flares in patients with giant-cell arteritis and …
Key Clinical Points
Giant-Cell Arteritis and Polymyalgia Rheumatica
- The immune-mediated diseases giant-cell arteritis and polymyalgia rheumatica occur in patients 50 years of age or older and are now recognized as chronic conditions.
- The diagnosis of giant-cell arteritis should be confirmed on the basis of histologic findings when possible.
- Glucocorticoids are the standard therapy for both giant-cell arteritis and polymyalgia rheumatica, with higher doses used for giant-cell arteritis.
- Disease flares in patients with giant-cell arteritis and polymyalgia rheumatica are common during the tapering of glucocorticoids and often respond to a 10 to 20% increase in dose.
- Arteritic ischemic optic neuropathy, which can result in blindness, should be treated as an emergency and requires prompt diagnosis and initiation of high-dose glucocorticoid therapy.
- In one quarter of patients with giant-cell arteritis, the aorta and its major branches are involved. Large-vessel disease is reliably diagnosed with computed tomography or magnetic resonance imaging.
- Longevity is generally not reduced by giant-cell arteritis or polymyalgia rheumatica, but glucocorticoid treatment often has adverse effects. Patients should be closely monitored, with attention to bone loss and consideration of prophylaxis against pneumocystis pneumonia.
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