RESEARCH - Small-vessel vasculitis surrounding an uninflamed temporal artery: a new diagnostic criterion for polymyalgia rheumatica?

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Arthritis Rheum. 2008 Aug;58(8):2565-73.

Small-vessel vasculitis surrounding an uninflamed temporal artery: a

new diagnostic criterion for polymyalgia rheumatica?

Chatelain D, Duhaut P, Loire R, Bosshard S, Pellet H, Piette JC,

Sevestre H, Ducroix JP.

Centre Hospitalier Universitaire du Nord and RECIF, Amiens, France.

OBJECTIVE: To assess the prevalence and clinical significance of

small-vessel vasculitis (SVV) surrounding an uninflamed temporal

artery (TA) in patients diagnosed as having giant cell (temporal)

arteritis (GCA) and/or polymyalgia rheumatica (PMR).

METHODS: Patients with GCA and/or PMR (n = 490) were included in this

multicenter prospective study. Slides of TA biopsy specimens were

reviewed by 2 pathologists who were blinded with regard to clinical

information. SVV was defined as aggregates of mononuclear inflammatory

cells surrounding a capillary, distant from an uninflamed temporal

artery. Clinical and biologic data of patients in the SVV group (n =

35) were compared with data of patients with biopsy-proven GCA (n =

280) and with negative TA biopsy findings (n = 175).

RESULTS: SVV was diagnosed in 18 women and 17 men (mean +/- SD age

74.5 +/- 9.4 years). The group of patients with SVV had a higher

proportion of men than in the entire GCA series, had systemic

symptoms, headache, jaw claudication, and an abnormal temporal artery

less frequently at clinical examination, but had symptoms of PMR more

often than patients in the biopsy-proven GCA group (P = 2.6 x 10(-7),

odds ratio 9.17 [95% confidence interval 3.44-24.4]). Levels of

inflammation markers were significantly lower in the SVV group.

Patients in the SVV group had fever less frequently than patients in

the group with negative TA biopsy findings, but otherwise shared the

same clinical (including PMR symptoms) and biologic features. Eighteen

of the 94 patients with pure PMR (19%) had SVV.

CONCLUSION: SVV is often neglected by pathologists, and appears to be

strongly associated with PMR symptoms in patients with a clinical

diagnosis of GCA and/or PMR. However, SVV as a new diagnostic

criterion for PMR must be assessed in prospective studies.

PMID: 18668584

http://www.ncbi.nlm.nih.gov/pubmed/18668584

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