A Case of Concomitant Peripheral Arterial Obstructive Disease and Polymyalgia Rheumatica

Case Report

Austin J Clin Case Rep. 2017; 4(3): 1124.

A Case of Concomitant Peripheral Arterial Obstructive Disease and Polymyalgia Rheumatica

Girardi L*

Gesundheitszentrum Wien-Mariahilf, Austria

*Corresponding author: Girardi L, Gesundheitszentrum Wien-Mariahilf, Mariahilferstraße 85-87, A-1060 Vienna, Austria

Received: July 05, 2017; Accepted: August 17, 2017; Published: September 08, 2017


A case of a patient with peripheral arterial obstructions is presented. We identified two conditions associated with vascular pathologies: diabetes mellitus and polymyalgia rheumatica. The findings, the course of the disease, and the response to cortison therapy taken into consideration, we reckon that both of these underlying conditions concomitantly caused the arterial changes: Proximal (femoral and popliteal) obstructions resolved with cortisol therapy, an angioplasty was performed for two infragenual lesions.

Keywords: Peripheral arterial disease (PAD); Diabetes mellitus; Atherosclerosis; Polymyalgia rheumatic (PMR); Giant cell arteritis (GCA)


PAD: Peripheral Arterial Disease; GCA: Giant Cell Arteriitis; PMR: Polymyalgia Rheumatica; MS: Metabolic Syndrome; DM: Diabetes Mellitus


The peripheral arterial disease (PAD) is in most cases caused by atherosclerosis which itself is in a large number of cases caused by diabetes mellitus (DM), i.e. the metabolic syndrome (MS). However, the giant cell arteritis (GCA), closely associated with the polymyalgia rheumatica (PMR) can also cause arterial obstructions. Although PAD and GCA are two distinct pathological entities, there is an increased risk for atherosclerosis in GCA patients.

Case Presentation

The 62 year old female patient presented with bilateral calf claudication after a walking distance of 100 to 200 meters over the last six months. It began on the right side, and was still felt more intensely and was lifestyle limiting on the right leg. No typical ischemic resting pain was reported, and there was no ulceration. The patient also complained of generalized muscle pain which she associated with the intake of a statin. Night sweats were reported, but no weight loss or elevated body temperature. The disease history included hypertension, hyperlipidaemia, osteoporosis, which were all medically treated, and a venous surgery. She had been smoking cigarettes until sometime earlier. The ankle-brachial-index was initially reduced on the right and within normal range on the left side. The Colour Doppler sonography and the Magnetic Resonance Imaging revealed moderate proximal bilateral stenosis in the superficial femoral arteries (more pronounced on the left side) and the left popliteal artery as well as relevant stenosis in the right tibiofibular trunk and in the right proximal posterior tibial artery. The peripheral arterial obstructive disease was diagnosed. Furthermore, carotid plaques were detected by sonography with a 50% stenosis in the left internal carotid artery. Aspirin (100 mg o.d.) was started in addition to the existing medication.

In the subsequent laboratory exams we diagnosed type 2 diabetes mellitus. The elevated sedimentation rate (30 mm/1h) in combination with the muscle pain led to the diagnosis of PMR, respectively GCA when vascular changes taken into consideration. A vessel biopsy was not performed due to the typical initial presentation combined with an elevated sedimentation rate and a good subsequent response to the corticosteroid therapy. The PMR was treated with tapering corticosteroid doses for about a year and a half, for DM the patient received metformin. The statin was replaced by ezetimibe (Figures1,2 and 3).