How common are giant cell arteritis symptoms in patients with polymyalgia rheumatica?: results from an incident primary care cohort

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
3D.1

The problem

Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of older people and causes significant levels of pain and disability. It is frequently associated with giant cell arteritis (GCA), a difficult to diagnose condition that can cause permanent visual impairment if not promptly treated with high dose glucocorticoids. This study investigates the co-existence of GCA symptoms in patients with PMR in primary care.

The approach

Data included in this analysis are taken from the baseline phase of the PMR Cohort Study, the first inception study of PMR in primary care. 739 people with new general practice diagnosis of PMR were mailed a baseline questionnaire, which included items relating to socio-demographic characteristics, general health and functioning, and PMR symptoms and treatments. In addition, participants were asked whether they had recently experienced a series of symptoms that would classically relate to GCA (including headache, scalp tenderness and jaw claudication). Descriptive statistics were used to describe the prevalence of these symptoms. Chi square statistics and t-tests were used to assess the association between these symptoms and gender and age respectively.

Findings

654 people responded to the baseline questionnaire (adjusted response rate 90.1%). The mean age (SD) of the sample was 72.4 (9.3) years and 62.2% were female. One or more potential GCA symptoms were reported by 387 (59.2%) people. With the exception of unplanned weight loss (prevalence 21.0%), all symptoms were more common in females than in males (sudden headache: females 30.7%, males 15.4%; tender scalp: 21.4%, 14.6%; disturbed/double vision: 21.1%, 10.5%; jaw claudication: 12.5%, 6.5%; fever: 17.7%, 10.9%; appetite loss: 25.1%, 15.4%). The mean age of those reporting and not reporting each symptom was similar, except for sudden headache and fever, where those reporting the symptom tended to be younger (headache: 70.3 (10.5) versus 73.1 (8.7) years; fever: 69.2 (9.4) versus 72.6 (9.1)). The most common combinations of symptoms were appetite loss and weight loss (4.4%) and headache and disturbed/double vision (2.6%).

Consequences

More than half of those with recently diagnosed PMR reported classical symptoms of GCA, with headache, scalp tenderness and visual disturbance being commonly reported in this cohort study. Follow-up data from this cohort will allow us to identify those at higher risk of developing GCA. On making a diagnosis of PMR it is important that GPs actively screen for symptoms that may be indicative of GCA to improve patient care and reduce the potential for the serious consequences associated with GCA. On-going patient education is essential so that patients are fully aware of red flag symptoms and empowered to seek help should they occur.

Credits

  • Christian D Mallen, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • Toby Helliwell, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • Sarah Lawton, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • James Prior, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • Rebecca Foskett
  • Irena Zwierska, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • Kevin Barraclough, Clinical Research Network West Midlands, Telford, Shropshire, UK
  • Bhaskar Dasgupta, Painswick Surgery, Painswick, Gloucestershire, UK
  • Samantha L Hider, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK
  • Sara Muller, Southend University Hospital Foundation Trust, Westcliff-on-Sea, Essex, UK