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Title: The epidemiology of polymyalgia rheumatica and giant cell arteritis
Author: Yates, Max
ISNI:       0000 0004 7227 2523
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2017
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Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available