From the Department of Internal medicine, Greater Baltimore Medical Center, Towson.
Department of Geriatrics, University of Maryland, Baltimore, MD.
J Clin Rheumatol. 2021 Jan 1;27(1):5-10. doi: 10.1097/RHU.0000000000001140.
Giant cell arteritis (GCA) is a systemic vasculitis that commonly co-occurs with polymyalgia rheumatica (PMR) in elderly patients. Pericardial disease is an unusual manifestation of these inflammatory conditions, which has been reported only in case reports and small observational studies. However, no extensive research has been performed to study the demographics and clinical history of GCA or PMR patients with concomitant pericardial features. As a result, the medical evidence to help guide the physicians when evaluating such individuals is limited.
To perform a systematic review of the medical literature in order to summarize the epidemiological and clinicopathological aspects of this unique association.
We conducted an extensive search of PubMed, Cochrane Library, Ovid, Google Scholar, and gray literature to identify all the cases of GCA and PMR with pericardial involvement. The demographics, clinical features, and outcomes of the final cohort were reviewed and analyzed.
The analysis comprised 52 clinical cases (51 identified from 46 articles and 1 from the residents' clinic). These included 44 patients with GCA and 8 with PMR. The mean age at presentation was 69.5 years, with only 46% of patients older than 70 years. The most common abnormality was pericardial effusion (85%), and in 37%, the pericardial event was the initial disease manifestation. Although a significant proportion of the patients were symptomatic (69%), the classic cranial symptoms were present in only 40%. Overall, the outcome was good even in the presence of large-vessel disease, which is usually a poor prognostic factor in classic GCA. On group analysis, patients with PMR were more likely to develop cardiac tamponade (37.5%; odds ratio, 25.8; confidence interval, 2.2-297.5; p = 0.01), whereas those with GCA were more likely to have large-vessel vasculitis (43%; odds ratio, 5.18; confidence interval, 0.58-252.1; p = 0.04).
This study illustrates that patients with pericardial involvement represent a clinical phenotype of GCA (and possibly PMR), which is quite different from the cranial or large-vessel forms. These patients have a better prognosis likely due to younger age and presence of more overt symptoms resulting in early diagnosis.
巨细胞动脉炎（GCA）是一种常见于老年患者的系统性血管炎，常与风湿性多肌痛（PMR）同时发生。心包疾病是这些炎症性疾病的一种不常见表现，仅在病例报告和小型观察性研究中有所报道。然而，尚无广泛的研究来研究伴有心包特征的 GCA 或 PMR 患者的人口统计学和临床病史。因此，用于评估此类个体的医学证据有限。
对医学文献进行系统回顾，以总结这种独特关联的流行病学和临床病理方面。
我们对 PubMed、Cochrane 图书馆、Ovid、Google Scholar 和灰色文献进行了广泛搜索，以确定所有伴有心包受累的 GCA 和 PMR 病例。回顾和分析最终队列的人口统计学、临床特征和结局。
分析包括 52 例临床病例（46 篇文章中的 51 例和 1 例来自住院医师诊所）。其中 44 例为 GCA，8 例为 PMR。发病时的平均年龄为 69.5 岁，只有 46%的患者年龄大于 70 岁。最常见的异常是心包积液（85%），37%的患者心包事件是初始疾病表现。尽管相当一部分患者有症状（69%），但仅有 40%存在典型颅神经症状。总体而言，即使存在大血管疾病，预后也很好，而大血管疾病通常是经典 GCA 的不良预后因素。在组分析中，PMR 患者更有可能发生心脏压塞（37.5%；优势比，25.8；置信区间，2.2-297.5；p=0.01），而 GCA 患者更有可能发生大血管血管炎（43%；优势比，5.18；置信区间，0.58-252.1；p=0.04）。
本研究表明，伴有心包受累的患者代表 GCA（可能还有 PMR）的一种临床表型，与颅神经或大血管形式明显不同。这些患者预后较好，可能是由于年龄较轻和存在更明显的症状，从而导致早期诊断。
