Polymyalgia Rheumatica and Giant Cell Arteritis

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3 Jozef Rovenský Burkhard F. Leeb Howard Bird Viera Štvrtinová Richard Imrich Editors Polymyalgia Rheumatica and Giant Cell Arteritis SpringerWienNewYork

4 Editors Prof. Jozef Rovenský, MD, DSc, FRCP, Slovakia Dr.BurkhardF.Leeb,Austria Prof. Howard Bird, MD, FRCP, United Kingdom Prof. Viera Štvrtinová, MD, PhD, Slovakia Dr. Richard Imrich, Slovakia Printed with financial support of Roche Slovensko s.r.p., Nycomed Slovakia s.r.o. and Abbot Slovakia Ltd. This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Product liability: The publisher can give no guarantee for the information contained in this book. This does also refer to information about drug dosage and application thereof. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use SAP Slovak Academic Press, Slovakia 2010 Springer-Verlag/Wien Printed in Germany SpringerWienNewYork is part of Springer Science+Business Media springer.at The publisher and editor kindly wish to inform you that in some cases, despite their efforts to do so, the obtaining of copyright permissions and usage of excerpts of text is not always successful. Photo Credits: NguyenGK,LeeMW,GinsbergJ,WraggT,BilodeauD.:Coverphoto with courtesy of Assoc. Prof. MD. I. Makaiová, PhD.: PET scan in Giant cell arteritis, fig. 23 and 24 (p. 91) all other figures with courtesy of the editors and authors Cover Design: WMXDesign GmbH, Heidelberg, Germany Typesetting: le-tex publishing services GmbH, Leipzig, Germany Printing and binding: Strauss GmbH, Mörlenbach, Germany Printed on acid-free and chlorine-free bleached paper SPIN: Library of Congress Control Number: With 27 colored figures ISBN SpringerWienNewYork

5 Preface In the present monograph, we offer current insights into polymyalgia rheumatica and giant cell arthritis. Both diseases are typical for advanced age, and their incidences increase with aging. Both diseases are a center point of interest not only for rheumatologists, gerontologists, ophthalmologists or neurologists, but also for general practitioners. Early diagnosis and rapid treatment, mainly with glucocorticoids can save one of the most precious senses-vision. Damage to other organs (heart, aorta, coronary arteries, liver, lungs, kidneys), which are supplied by the arteries affected by ischemic syndrome in the setting of giant cell arthritis, has serious consequences as well. Late diagnosis of giant cell arthritis can have fatal consequences for affected patients. It is a matter of fact that the human population is aging. Therefore, more attention has to be paid not only to diagnosis, clinical course and treatment of rheumatic diseases in elderly, but also to their genetic, immunologic, endocrinologic, chronobiologic mechanisms, and state-of-the-art diagnostic modalities. I am convinced that the interdisciplinary research of the diseases will allow us to diagnose and treat the rheumatic diseases even faster and more effectively in the future. The monograph is a result of cooperation among five institutions; the National Institute of Rheumatic Diseases in Piestany, Slovakia; Clinical Pharmacology Unit, Chapel Allerton Hospital Leeds, United Kingdom, the Department of Rheumatology in Stockerau, Austria; the Medical School of Comenius University in Bratislava and the Institute of Experimental Endocrinology in Bratislava, Slovakia. It is my great pleasure to appreciate the Slovak Research and Development Agency (APVV) for its financial support of polymyalgia rheumatica and giant cell arthritis research (this work was supported by Science and Technology Assistance Agency under the contract. No APVT ). On behalf of all authors, Prof. MUDr. Jozef Rovenský, DSc. FRCP

6 Contents 1 Polymyalgia Rheumatica and Giant Cell Arteritis an overview with a focus on important factors contributing to the severity of the disease... 1 Jozef Rovenský, Burkhard F. Leeb, Viera Štvrtinová, Richard Imrich, Juraj Duda 2 Polymyalgia Rheumatica, Temporal Arteritis and Occurrence of Malignant Tumors Jozef Rovenský, Alena Tuchyňová 3 Coronary involvement and atherosclerosis in Giant Cell Arteritis Viera Štvrtinová, Jozef Rovenský, Alena Tuchyňová 4 T cells and their role in Polymyalgia Rheumatica and Giant Cell Arteritis Stanislava Blažíčková, Jozef Rovenský 5 Cytokines in Polymyalgia Rheumatica and Giant Cell Arteritis Jozef Rovenský, Richard Imrich 6 Genetic factors in Giant Cell Arteritis and Polymyalgia Rheumatica Vladimír Bošák 7 Polymyalgia rheumatica (PMR) and vascular complications Viera Štvrtinová, Svetoslav Štvrtina, Jozef Rovenský 8 Chronobiology of Polymyalgia Rheumatica and Giant Cell Arteritis Howard Bird

7 viii Contents 9 Histopathology of Giant Cell (temporal) Arteritis changes in aorta Svetoslav Štvrtina, Jozef Rovenský 10 Ultrasonography in Polymyalgia Rheumatica and/or Giant Cell Arteritis Peter Poprac, Jozef Rovenský 11 Therapy of Polymyalgia Rheumatica and Giant Cell Arteritis Jozef Rovenský, Richard Imrich 12 Diagnostic Criteria, Treatment, and Monitoring of Polymyalgia Rheumatica/Giant Cell Arteritis Burkhard F. Leeb, Thomas Nothnagl, Martin Steindl, Bernhard Rintelen Figures... 83

8 List of Contributors Prof. Howard Bird, MD, FRCP Clinical Pharmacology Unit, Chapel Allerton Hospital Leeds, United Kingdom Ass. Prof. Stanislava Blažíčková, Ing. PhD Slovakia National Institute of Rheumatic Diseases, Piešťany, Slovakia Ass. Prof. Vladimír Bošák, Dr. PhD Slovakia National Institute of Rheumatic Diseases, Piešťany, Slovakia Faculty of Health, Care and Social Work, Trnava University, Trnava, Slovakia Juraj Duda, MD County Hospital, Michalovce, Slovakia

9 x List of Contributors Richard Imrich, MD, PhD Slovakia Center for Molecular Medicine, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovakia Dr. Burkhard F. Leeb 1 st and 2 nd Department of Medicine, Center for Rheumatology, Lower Austria; State Hospital Stockerau, Karl Landsteiner Institute for Clinical Rheumatology Stockerau, Austria burkhard.leeb@stockerau.lknoe.at; leeb.rheuma@aon.at Thomas Nothnagl 1 st and 2 nd Department of Medicine, Centre for Rheumatology, Lower Austria; State Hospital Stockerau; Karl Landsteiner Institute for Clinical Rheumatology. Stockerau, Austria thomas.nothnagl@stockerau.lknoe.at Assoc. Prof. Peter Poprac MD, PhD Slovakia National Institute of Rheumatic Diseases, Piešťany, Slovakia poprac@nurch.sk Bernhard Rintelen 1 st and 2 nd Department of Medicine, Centre for Rheumatology, Lower Austria; State Hospital Stockerau; Karl Landsteiner Institute for Clinical Rheumatology. Stockerau, Austria bernhard.rintelen@stockerau.lknoe.at Prof. Jozef Rovenský, MD, DSc, FRCP, Slovakia National Institute of Rheumatic Diseases, Piešťany, Slovakia rovensky.jozef@nurch.sk