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Rheumatology 2005 44(Supplement 3):iii16-iii17; doi:10.1093/rheumatology/keh761
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Supplement Article

PP8. GIANT CELL ARTERITIS AND POLYMYALGIA RHEUMATICA: DIAGNOSTIC ERRORS REVEALED BY A LONG TERM PROSPECTIVE FOLLOW UP – THE GRACG MULTICENTRIC STUDY

P. Duhaut1, S. Bosshard2, L. Le Page1, D. Boutin3, A. Smail1, R. Cevallos1, V. Salle1, R. Loire4, H. Pellet5, J. C. Piette3 and J. P. Ducroix1

1 Department of Internal Medicine and RECIF, CHU Nord, Amiens, France, 2 Laboratory of Virology and 5 RECIF, Lyon-Grange-Blanche School of Medicine, Lyon, France, 3 Department of Internal Medicine 2, Pitié-Salpêtrière Hospital, Paris, France, 4 Laboratory of Pathology, Louis Pradel Hospital, Lyon, France

Background: Our goal was to assess in a multicenter, prospective cohort study with diagnosis revision during follow-up, the rate of false positive diagnosis, the differential diagnoses and the potential predictive factors of diagnostic errors in GCA and/or PMR patients.

Methods: Fifty hundred and fifty eight patients have been included at the time of diagnosis between 1991 and 2003 (203 ‘pure’ GCA, 161 ‘pure’ PMR, 194 patients with both PMR and GCA). All GCA patients fulfilled the ACR criteria, and all PMR patients, the Bird criteria. All temporal artery biopsies have been reviewed by a referent pathologist. On a five-year follow-up, 21 diagnoses have been corrected (3.8%): 2 biopsy proven GCA, 7 negative biopsy GCA, and 12 PMR. All patients responded to steroid therapy at the onset of the disease.

Results: In these 21 patients, diagnoses finally performed were: rheumatoid arthritis: 5; cancer: 4; osteoarthritis: 3; spondylarthropathy: 2; Osler endocartitis: 1; polymyositis: 1; Wegener's disease: 1; bilateral glaucoma with blindness: 1; chondrocalcinosis: 1; undetermined: 2.

The new diagnosis was made for 10 of them, after the 24th month of follow-up. Initial biological features (ESR, CRP, platelets, hemoglobin, leucocytes, fibrinogen) were similar in patients with maintained, or corrected, diagnosis. Headache was less frequent (p = 0.002), PMR symptoms more frequent (p = 0.023) in patients with corrected diagnosis. Cortico-resistance at 20 mg of predisolone during dose tapering at 12 months of follow-up was the best predictive factor of false diagnosis (OR: 19.2: 95% CI: 4.27–83.3, p = 0.002). Both clinical and biological relapse rates were similar in patients with maintained, and corrected, diagnosis.

Conclusion: The rate of false diagnosis is probably underestimated in steroid-respondent patients with PMR and/or negative biopsy GCA. However, occurrence of steroid resistance should lead to diagnosis revision.


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