Abstract
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are the autoimmune diseases occuring after 50 years of age with maximum around seventy - eighty years of age. Their common apearance indicates, that both diseases have an unknown etiopathogenetic denominator until now.
On the other hand their symptoms and prognosis are completely different. PMR symptoms are painfull stiffness in the pelvic, schoulder girdle and nuchal muscles.
GCA is often accompanied by headaches caused by affection of blood vessels in the area of artery carotis comunis and interna, nodular enlargement of the temporal artery branches is often seen. Usual and feared sign of GCA is sudden blindness as a result of vascular oclussion of vessels causing optic nerve ischemia.
Immunopatologic inflammation is the essence of both diseases and manifests by high value of reactans of acute phase (Erythrocyte Sedimentation Rate, C-reactive protein levels). There is no specific diagnostic blood or plasma test available yet.
The diagnosis of PMR lies in clinical picture and exclusion of other diferential options. The diagnosis of GCA is primarily based on the typical histological picture of arterial wall.
Nowadays the imaging modalities are very helpful for diagnosis, for example positron emission tomography in the combination with the computer tomography. The gold standard in the treatment of both diseases is long-term (at least 1 or 2 years) administration of glucocorticoids with gradual reduction of dosage.
Of course this treatment is accompained by a variety of commonly known advers effects. In both cases there is a typical significant improvement of health condition very soon after therapy initiation.
PMR therapy is consisted of prednison 15-20 mg daily, the inital treatment of GCA is 2-3x higher dosage of corticosteroids. In the case of imminent threat of blindness the prompt high-dose intravenous administration of corticosteroids is essential.