The epidemiology of polymyalgia rheumatica and giant cell arteritis

Yates, Max (2017) The epidemiology of polymyalgia rheumatica and giant cell arteritis. Doctoral thesis, University of East Anglia.

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The epidemiology of polymyalgia rheumatica (PMR) and giant cell arteritis
(GCA) is poorly characterised, with little known about the aetiological
factors involved in disease onset and progression. This project aimed to
determine the incidence and prevalence of PMR and GCA, including their
related morbidity, and to investigate aetiological hypotheses for disease
onset and progression using community-based populations and
contemporary classification criteria.
Three large phenotypically informative datasets were constructed:
GCANS (n = 4,728), EPIC-Norfolk (n = 25,660) and DCVAS (n = 712) to
establish the descriptive epidemiology and investigate aetiological
hypotheses centred on cardiovascular risk factors in cross-sectional and
longitudinal study designs. The EPIC cohort included unique data from
retinal photographs, allowing the application of vasculometric analysis.
The prevalence ranged from 0.91% to 1.62% for PMR and 0.25% to
0.47% for GCA. Age and traditional cardiovascular risk factors were
important for both disease onset with associations between hypertension
and LDL with PMR. Visual impairment developed in 8% of GCA cases with
six months of onset; risk factors for blindness in GCA included peripheral
vascular disease. Inflammatory arthritis developed in 10% of PMR cases
at 10 years with greatest risk in smokers. Analysis of retinal photographs
showed an association between venular width and PMR, but no other
characteristic morphological features were identified.
These are the first estimates of PMR and GCA incidence and prevalence
for the UK to apply current classification criteria. This is the first study to
use a prospective design to show traditional cardiovascular risk factors to
be important for disease onset and progression; their presence may point
towards a need for more careful monitoring. The novel vasculometric
data from retinal photographs provides insight into aetiological
hypotheses of disease, particularly those with underlying vascular
dysregulation mechanisms, and may be of potential value in screening.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Jackie Webb
Date Deposited: 30 Apr 2018 11:42
Last Modified: 30 Apr 2018 11:42


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