Giant cell arteritis polymalgia rheumatica spectrum disease

Join ARU's Medical Technology Research Centre (MTRC) online for a seminar from Prof Bhaskar Dasgupta (Southend University Hospital) about the case for linking the diseases giant cell arteritis (GCA) and polymyalgia rheumatica (PMR).

GCA and PMR are closely related conditions characterised by systemic inflammation, a predominant IL-6 signature, an excellent response to glucocorticoids, a tendency to a chronic and relapsing course, and older age of the affected population.

This seminar will highlight the emerging view that these diseases should be approached as linked conditions, unified under the term GCA–PMR spectrum disease (GPSD).

In addition, GCA and PMR should be seen as non-monolithic conditions, with different risks of developing acute ischaemic complications and chronic vascular and tissue damage, different responses to available therapies and disparate relapse rates.

A comprehensive stratification strategy for GPSD, guided by clinical findings, imaging and laboratory data, facilitates appropriate therapy and cost-effective use of health-economic resources.

Patients presenting with predominant cranial symptoms and vascular involvement, who usually have a borderline elevation of inflammatory markers, are at an increased risk of sight loss in early disease but have fewer relapses in the long term, whereas the opposite is observed in patients with predominant large-vessel vasculitis. How the involvement of peripheral joint structures affects disease outcomes remains uncertain and understudied.

In the future, all cases of new-onset GPSD should undergo early disease stratification, with their management adapted accordingly.

Key reference: Tomelleri, A., van der Geest, K. S. M., Khurshid, M. A., Sebastian, A., Coath, F., Robbins, D., Pierscionek, P., Dejaco, C., Matteson, E., van Sleen, Y. and Dasgupta, B. (2023) 'Disease stratification in GCA and PMR: state of the art and future perspectives', Nature Reviews Rheumatology, 19(7), pp. 446-459. Available at: https://doi.org/10.1038/s41584-023-00976-8

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