Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study

Andreas Wiggers Nielsen; Ellen-Margrethe Hauge; Ib Tønder Hansen; Berit Dalsgaard Nielsen; Søren Geill Kjær; Jesper Blegvad; Kate Rewers; Christian Møller Sørensen; Lars Christian Gormsen; Kresten Krarup Keller

doi:10.1093/rheumatology/keae463

Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study

Andreas Wiggers Nielsen^*, Ellen-Margrethe Hauge, Ib Tønder Hansen, Berit Dalsgaard Nielsen, Søren Geill Kjær, Jesper Blegvad, Kate Rewers, Christian Møller Sørensen, Lars Christian Gormsen, Kresten Krarup Keller

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

3 Citations (Scopus)

Abstract

Objective: 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). Methods: 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. Results: 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. Conclusion: 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.

Original language	English
Journal	Rheumatology
Volume	64
Issue	4
Pages (from-to)	2193-2198
Number of pages	6
ISSN	1462-0324
DOIs	https://doi.org/10.1093/rheumatology/keae463
Publication status	Published - 1 Apr 2025

Keywords

FDG-PET/CT
incidence
late-onset giant cell arteritis
polymyalgia rheumatica
subclinical giant cell arteritis
vascular ultrasonography

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10.1093/rheumatology/keae463

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Nielsen, A. W., Hauge, E.-M., Hansen, I. T., Nielsen, B. D., Kjær, S. G., Blegvad, J., Rewers, K., Møller Sørensen, C., Gormsen, L. C., & Keller, K. K. (2025). Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study. Rheumatology, 64(4), 2193-2198. https://doi.org/10.1093/rheumatology/keae463

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title = "Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study",

abstract = "Objective: 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). Methods: In this prospective study, treatment-na{\"i}ve 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. Results: 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. Conclusion: 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.",

keywords = "FDG-PET/CT, incidence, late-onset giant cell arteritis, polymyalgia rheumatica, subclinical giant cell arteritis, vascular ultrasonography",

author = "Nielsen, {Andreas Wiggers} and Ellen-Margrethe Hauge and Hansen, {Ib T{\o}nder} and Nielsen, {Berit Dalsgaard} and Kj{\ae}r, {S{\o}ren Geill} and Jesper Blegvad and Kate Rewers and {M{\o}ller S{\o}rensen}, Christian and Gormsen, {Lars Christian} and Keller, {Kresten Krarup}",

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doi = "10.1093/rheumatology/keae463",

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Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study. / Nielsen, Andreas Wiggers; Hauge, Ellen-Margrethe; Hansen, Ib Tønder et al.
In: Rheumatology, Vol. 64, No. 4, 01.04.2025, p. 2193-2198.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study

AU - Nielsen, Andreas Wiggers

AU - Hauge, Ellen-Margrethe

AU - Hansen, Ib Tønder

AU - Nielsen, Berit Dalsgaard

AU - Kjær, Søren Geill

AU - Blegvad, Jesper

AU - Rewers, Kate

AU - Møller Sørensen, Christian

AU - Gormsen, Lars Christian

AU - Keller, Kresten Krarup

PY - 2025/4/1

Y1 - 2025/4/1

N2 - Objective: 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). Methods: 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. Results: 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. Conclusion: 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.

AB - Objective: 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). Methods: 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. Results: 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. Conclusion: 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.

KW - FDG-PET/CT

KW - incidence

KW - late-onset giant cell arteritis

KW - polymyalgia rheumatica

KW - subclinical giant cell arteritis

KW - vascular ultrasonography

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U2 - 10.1093/rheumatology/keae463

DO - 10.1093/rheumatology/keae463

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SN - 1462-0324

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JO - Rheumatology

JF - Rheumatology

IS - 4

ER -

Low incidence of late-onset giant cell arteritis during the first year in patients with polymyalgia rheumatica-a repeated imaging study

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