Abstract
Patients with polymyalgia rheumatica have been shown to have an increased risk of peripheral arterial disease on longitudinal follow-up. Possible explanations for this include premature atherosclerosis related to chronic inflammation, as with other inflammatory rheumatological conditions. Alternatively, polymyalgia rheumatica can be associated with vasculitis, even in the absence of clinical giant cell arteritis, and peripheral vascular disease may represent subclinical vasculitis. Further work is required to elucidate the reasons for this increased risk. Currently, it would remain reasonable to aggressively control modifiable atherosclerotic risk factors.
Highlights
Warrington and colleagues report an increased risk of peripheral arterial disease (PAD) in patients with polymyalgia rheumatica (PMR) compared with matched controls [1]
An increased risk of cardiovascular disease is well established in inflammatory rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis [3], over and above the risk explained by conventional cardiovascular risk factors
This increase appears to be related to chronic inflammation, with elevated levels of C-reactive protein associated with increased risk of cardiovascular disease, including PAD [4]
Summary
Warrington and colleagues report an increased risk of peripheral arterial disease (PAD) in patients with polymyalgia rheumatica (PMR) compared with matched controls [1]. This increase appears to be related to chronic inflammation, with elevated levels of C-reactive protein associated with increased risk of cardiovascular disease, including PAD [4]. Warrington and colleagues found no correlation between PAD and PMR-related disease characteristics or the erythrocyte sedimentation rate at diagnosis, patients with PMR were at 2.5-fold increased risk even when adjusted for conventional risk factors for atherosclerosis [1].
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