G. Myklebust

Bio: G. Myklebust is an academic researcher from Hospital of Southern Norway. The author has contributed to research in topics: Giant cell arteritis & Polymyalgia rheumatica. The author has an hindex of 13, co-authored 37 publications receiving 1030 citations. Previous affiliations of G. Myklebust include University of Tromsø & Haukeland University Hospital.

The fast-track ultrasound clinic for early diagnosis of giant cell arteritis significantly reduces permanent visual impairment: towards a more effective strategy to improve clinical outcome in giant cell arteritis?

Abstract: OBJECTIVE Permanent visual impairment has been reported to occur in up to 19% of GCA patients. The aim of this study was to examine whether implementation of a fast-track approach could reduce the rate of permanent visual impairment and inpatient days of care in GCA patients. METHODS A fast-track outpatient GCA clinic (FTC) was implemented in the Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Norway in 2012. The patients included in this study were subsequently recruited between March 2010 and October 2014. Routine clinical and laboratory data and number of inpatient days of care were collected. RESULTS During the observation period, 75 patients were diagnosed with GCA. Among the 75 GCA patients, 32 were evaluated conventionally and 43 in the FTC. In the conventionally approached group, six patients suffered from permanent visual impairment, while in the FTC group only one patient suffered from permanent visual impairment. The relative risk of permanent visual impairment in the GCA patients examined in the FTC was 88% lower compared with the conventionally evaluated group (relative risk 0.12, 95% CI: 0.01, 0.97, P = 0.01). The mean difference in inpatient days of care between patients evaluated conventionally and patients evaluated in the FTC was 3 days (3.6 vs 0.6 days, P < 0.0005). CONCLUSION The implementation of the FTC in GCA care appears to significantly reduce the risk of permanent visual impairment and is more cost effective by reducing the need for inpatient care.

A prospective study of 287 patients with polymyalgia rheumatica and temporal arteritis: clinical and laboratory manifestations at onset of disease and at the time of diagnosis

Abstract: SUMMARY A prospective study of 287 patients with giant cell arteritis (GCA), including polymyalgia rheumatica (PMR) and temporal arteritis (TA), was conducted during 1987-1994. All patients were evaluated prior to the start of drug treatment. During the same period, 31 patients with GCA, of whom 12 cases had TA, were admitted to other departments in the hospital. At onset of disease, all patients were 5= 50 yr of age. Peripheral arthritis was found in 24.4% of patients with PMR, while none of the patients with TA exhibited such manifestations. Clinical features at onset of disease differed from those appearing at presentation to the hospital. Thus, the gradual development of a full-blown clinical picture may be responsible for the delay in diagnosis of GCA. The majority of cases (80%) presented with 'pure' PMR without clinical signs or symptoms of concomitant TA. In a random sample of 68 patients with 'pure' PMR, histological examinations of biopsy specimens of the temporal artery revealed inflammatory changes in three patients only (4.4%). Consequently, arterial biopsy in patients with clinical features of PMR only, appears to be unnecessary. Among patients with TA referred to the department of internal medicine, general malaise, loss of weight and sustained fever were prominent manifestations. Such features may thus necessitate a diagnostic arterial biopsy even in the absence of clinical arteritis or myalgia. Both ESR and CRP were within normal levels in 1.2% of the cases. Further clinical and laboratory examinations performed at diagnosis of GCA disclosed only one case of malignancy. Routine chest X-rays did not reveal unexpected pathological findings. Permanent and complete blindness due to arteritis was observed in one patient only. No association between GCA and thyroid dysfunction was detected. POLYMYALGIA rheumatica (PMR) and temporal arteritis (TA) are usually considered as two different clinical expressions of the same disease, often termed giant cell arteritis (GCA). The clinical and laboratory features of the disorder have been the subject of numerous surveys during the last few decades. However, the majority of studies on GCA have been conducted on selected patients referred to hospital, whereas population surveys or observations of unselected cases have been performed more infrequently. The aim of the present investigation was to study the clinical and laboratory manifestations of GCA prior to the start of drug therapy in an unselected group of patients referred to hospital. Moreover, the prospective design of the study enabled us to evaluate the course, duration and mortality of the disease, and the incidence of malignancy among the patients. We now report on the clinical and laboratory findings at onset and at presentation.

The incidence of polymyalgia rheumatica and temporal arteritis in the county of Aust Agder, south Norway: a prospective study 1987-94.

Abstract: Objective To determine the incidence of giant cell arteritis (GCA) including polymyalgia rheumatica (PMR) and temporal arteritis (TA) in a region of South Norway. Methods All physicians in the county were asked to refer all patients suspected of having PMR or TA to the Department of Rheumatology. Patients meeting diagnostic criteria and with disease onset during 1987-94 were included in a prospective study. In addition, all cases admitted to hospital departments other than rheumatology were evaluated retrospectively. Results In total, 322 patients with PMR or TA were found. The annual incidence of GCA per 100,000 population aged 50 years or more was 141.7, 177.6 in women and 99.5 in men. Pure PMR was found in 256 cases, while 66 patients had biopsy verified TA. The annual incidence of pure PMR per 100,000 residents aged 50 years or more was 112.6, 137.7 in women and 83.2 in men. The annual incidence of TA in persons 50 years and older was 29.0 per 100,000, 39.9 in women and 16.3 in men. Conclusion The high incidence of GCA we found was due to excess of cases with pure PMR. The high number of cases with PMR was most likely due to the design of the study, allowing inclusion of patients usually not detected by retrospective hospital based studies.

Diagnostic Value of Color Doppler Ultrasonography of Temporal Arteries and Large Vessels in Giant Cell Arteritis: A Consecutive Case Series

Abstract: Objective Color Doppler ultrasonography (CDUS) can detect inflammation in the vessel wall. No studies have evaluated the examination of the common carotid artery by CDUS in the diagnostics of giant cell arteritis (GCA). Our aim was to evaluate the combination of CDUS examination of the temporal, axillary, and common carotid arteries in the diagnosis of GCA. Methods Patients ages ≥50 years who were referred to our department between April 2010 and October 2012 and suspected to have GCA were consecutively examined. A positive clinical evaluation for GCA 6 months after the first evaluation by 3 rheumatologists was considered as the gold diagnostic standard. All patients underwent CDUS of the temporal, axillary, and common carotid arteries. A biopsy of the temporal artery was performed for most patients. Results A total of 88 patients were assessed. Forty-six patients were diagnosed to have GCA by the defined gold standard. Forty-eight patients had a positive CDUS of the temporal artery. Forty-six patients diagnosed with GCA had a positive CDUS of the temporal, common carotid, and axillary arteries (100% sensitivity) and 4 patients had a positive CDUS without having GCA (91% specificity). Among the 39 GCA patients that underwent a biopsy, vasculitis was observed in 26 patients (66%), yielding a sensitivity of 67% and a specificity of 95%. Conclusion CDUS of the common carotid, axillary, and temporal arteries had an excellent sensitivity and high specificity to diagnose GCA. CDUS has the potential to replace biopsy in ordinary clinical care without compromising on sensitivity and specificity.

Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls

Abstract: Objective. To estimate survival in polymyalgia rheumatica (PMR) and temporal arteritis (TA). Methods. The present study encompassed 338 incident cases who were diagnosed at the Department of Rheumatology during the period 1987-1997 and 60 cases diagnosed in the same period but admitted to hospital for reasons other than PMR or TA. The 398 patients were each assigned four age- and sex-matched controls from the same population and mortality ascertained. Results. Among the 338 incident cases, there were 69 deaths compared with 360 deaths among their 1352 controls. The mortality was thus 28% lower in cases than in controls [relative risk (RR) = 0.72, 95% confidence interval (CI) 0.55-0.95]. The 274 incident cases with pure PMR had increased survival compared with controls (RR = 0.70, 95% CI 0.52-0.95), whilst among the 64 incident TA patients and their controls, no difference in mortality was found (RR = 1.2, 95% CI 0.55-2.74). Patients diagnosed at other departments and their controls had the same mortality. In the incident cases, the mean initial dose of prednisolone, the mean maintenance dose of prednisolone, the mean initial erythrocyte sedimentation rate and C-reactive protein and frequency of peripheral arthritis did not differ between survivors and those dying during the observation period. Conclusion. The study showed increased survival in patients with PMR compared with controls, whilst mortality in TA equalled that of controls. There was no association between use of corticosteroids and level of disease activity and death. The increased survival in PMR might be explained by improved medical surveillance.

Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II.

Abstract: Objective To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions.

National Arthritis Data Work-group. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II

Abstract: OBJECTIVE To provide a single source for the best available estimates of the US prevalence of and number of individuals affected by osteoarthritis, polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional conditions. METHODS The National Arthritis Data Workgroup reviewed published analyses from available national surveys, such as the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data based on national population samples are unavailable for most specific rheumatic conditions, we derived estimates from published studies of smaller, defined populations. For specific conditions, the best available prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau, to estimate the number affected with each condition. RESULTS We estimated that among US adults, nearly 27 million have clinical osteoarthritis (up from the estimate of 21 million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have fibromyalgia, 4-10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3 months, and 30.1 million have had neck pain in the past 3 months. CONCLUSION Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the US population. This report provides the best available prevalence estimates for the US, but for most specific conditions more studies generalizable to the US or addressing understudied populations are needed.

The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis.

Abstract: Studies of oral corticosteroid dose and loss of bone mineral density have reported inconsistent results. In this meta-analysis, we used information from 66 papers on bone density and 23 papers on fractures to examine the effects of oral corticosteroids on bone mineral density and risk of fracture. Strong correlations were found between cumulative dose and loss of bone mineral density and between daily dose and risk of fracture. The risk of fracture was found to increase rapidly after the start of oral corticosteroid therapy (within 3 to 6 months) and decrease after stopping therapy. The risk remained independent of underlying disease, age and gender. We conclude that oral corticosteroid treatment using more than 5 mg (of prednisolone or equivalent) daily leads to a reduction in bone mineral density and a rapid increase in the risk of fracture during the treatment period. Early use of preventive measures against corticosteroid-induced osteoporosis is recommended.

The endogenous Toll-like receptor 4 agonist S100A8/S100A9 (calprotectin) as innate amplifier of infection, autoimmunity, and cancer

Abstract: The innate immune system is crucial for initiation and amplification of inflammatory responses. During this process, phagocytes are activated by PAMPs that are recognized by PRRs. Phagocytes are also activated by endogenous danger signals called alarmins or DAMPs via partly specific, partly common PRRs. Two members of the S100 protein family, S100A8 and S100A9, have been identified recently as important endogenous DAMPs. The complex of S100A8 and S100A9 (also called calprotectin) is actively secreted during the stress response of phagocytes. The association of inflammation and S100A8/S100A9 was discovered more than 20 years ago, but only now are the molecular mechanisms involved in danger signaling by extracellular S100A8/S100A9 beginning to emerge. Taking advantage of mice lacking the functional S100A8/S100A9 complex, these molecules have been identified as endogenous activators of TLR4 and have been shown to promote lethal, endotoxin-induced shock. Importantly, S100A8/S100A9 is not only involved in promoting the inflammatory response in infections but was also identified as a potent amplifier of inflammation in autoimmunity as well as in cancer development and tumor spread. This proinflammatory action of S100A8/S100A9 involves autocrine and paracrine mechanisms in phagocytes, endothelium, and other cells. As a net result, extravasation of leukocytes into inflamed tissues and their subsequent activation are increased. Thus, S100A8/S100A9 plays a pivotal role during amplification of inflammation and represents a promising new therapeutic target.