Nielsen Andreas Wiggers, Hauge Ellen-Margrethe, Hansen Ib Tønder, Nielsen Berit Dalsgaard, Kjær Søren Geill, Blegvad Jesper, Rewers Kate, Møller Sørensen Christian, Gormsen Lars Christian, Keller Kresten Krarup
Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Rheumatology (Oxford). 2025 Apr 1;64(4):2193-2198. doi: 10.1093/rheumatology/keae463.
The objective was to investigate the incidence of late-onset giant cell arteritis (GCA) within the first year in patients diagnosed with polymyalgia rheumatica (PMR).
In this prospective study, treatment-naïve individuals with a new clinical diagnosis of PMR and without GCA symptoms underwent baseline assessments, including vascular ultrasonography and 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (FDG-PET/CT). To prevent biased inclusion, rapid referral clinics were established for all patients suspected of PMR. Additionally, the patients underwent GCA monitoring during clinical visits at weeks 8 and 10, which involved vascular ultrasonography and FDG-PET/CT scans. After one year, a follow-up visit was performed to confirm the PMR diagnosis and perform vascular ultrasonography.
A final PMR diagnosis was assigned to 62 patients, excluding two patients with concurrent subclinical GCA and PMR at baseline, corresponding to a baseline prevalence of subclinical GCA of 3%. During the one-year follow-up, two PMR patients developed late-onset GCA corresponding to an incidence rate of 32 per 1000 person-years. One patient developed GCA 14 weeks after the PMR diagnosis, exhibiting cranial symptoms and positive vascular ultrasonography. The other patient presented with subclinical large vessel GCA at the one-year visit detected with vascular ultrasonography and confirmed by FDG-PET/CT.
This study is the first to demonstrate a low incidence rate of late-onset GCA in PMR patients within the first year, employing repeated imaging to exclude GCA at baseline and diagnose GCA during follow-up. Additionally, it provides evidence of a low prevalence of subclinical GCA across the entire PMR population.
ClinicalTrials.Gov, NCT04519580.
本研究旨在调查多肌痛（PMR）患者在诊断后的第一年内迟发性巨细胞动脉炎（GCA）的发病率。
在这项前瞻性研究中，初治的新确诊为PMR且无GCA症状的个体接受了基线评估，包括血管超声检查和2-[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描计算机断层扫描（FDG-PET/CT）。为防止纳入偏倚，为所有疑似PMR的患者设立了快速转诊诊所。此外，患者在第8周和第10周的临床就诊期间接受了GCA监测，包括血管超声检查和FDG-PET/CT扫描。一年后，进行随访以确认PMR诊断并进行血管超声检查。
最终有62例患者被诊断为PMR，排除了2例在基线时同时患有亚临床GCA和PMR的患者，亚临床GCA的基线患病率为3%。在一年的随访中，有2例PMR患者发生了迟发性GCA，发病率为每1000人年32例。1例患者在PMR诊断后14周发生GCA，表现为颅脑症状且血管超声检查呈阳性。另一例患者在一年随访时经血管超声检查发现亚临床大血管GCA，并经FDG-PET/CT证实。
本研究首次证明了PMR患者在第一年内迟发性GCA的发病率较低，采用重复成像在基线时排除GCA并在随访期间诊断GCA。此外，它还提供了整个PMR人群中亚临床GCA患病率较低的证据。
ClinicalTrials.Gov，NCT04519580。
