Assessment of vascular involvement in polymyalgia rheumatica (PMR) patients by duplex ultrasound

Abstract

Aim of the work

To assess the vascular involvement consistent with giant cell arteritis (GCA) in polymyalgia rheumatica (PMR) patients by duplex ultrasound (US).

Patients and methods

Twenty PMR patients and 20 matched healthy controls were recruited. Vascular duplex was performed for: common carotid artery (CCA), extracranial part of internal carotid artery (ICA), external carotid artery (ECA), superficial temporal artery (STA), frontal and occipital arteries. Vessels were considered abnormal if Outcome Measures in Rheumatology (OMERACT) definitions for GCA were found; or if intima media thickness (IMT) exceeded respective cut-off values: ≥0.4 mm for STA, frontal and occipital arteries, ≥1mm for CCA, ECA and ICA.

Results

Included PMR patients were females, with mean ages of 56.5 ± 4.5 years. Vascular findings suggestive of GCA by duplex US were found in 14/20 PMR patients (70 %)(sonography pathological group), and subclinical vasculitis was reported in 10/14 PMR patients (71.4 %). The STA was affected in 85.7 %, occipital in 71.4 %, frontal in 64.3 %, ECA 35.7 %, CCA 28.6 % and ICA 28.6 %. Overlap pattern (cranial and extra-cranial) was observed in 8/14 PMR patients (57.1 %); while cranial pattern in 42.9 % and none had isolated extra-cranial affection. Halo sign, stenosis and occlusion were detected in none of PMR patients. Significantly longer duration of the current steroid therapy was found in sonography pathological group (16 ± 9.95 months) versus pure PMR patients (2 ± 1.4 months)(p = 0.03).

Conclusion

Subclinical vascular involvement suggestive of GCA has been depicted in the studied PMR patients, implying that sonographic assessment of group set of vessels by vascular duplex is warranted in PMR.