THROMBOCYTOSIS IN POLYMYALGIA-RHEUMATICA

Basic problem and objective of study: The diagnosis of polymyalgia rhe umatica is made difficult by the absence of any pathognomonic findings . Erythrocyte sedimentation rate (ESR) and concentration of C-reactive protein are used as diagnostic criteria and to monitor the disease's course. It was the purpose of this study to evaluate prevalence of thr ombocytosis and whether there is any correlation between thrombocytosi s and ischaemic complications. Patients and methods: In a retrospectiv e study the data of 23 patients (14 women, 9 men; mean age 67.3 [48-84 ] years) with polymyalgia rheumatica were analysed: platelet counts, E SR and C-reactive protein had been measured at the time of diagnosis a nd 7, 14 and 21 days after start of glucocorticoid treatment. At the t ime of diagnosis 17 of 23 patients (74%) had a thrombocytosis (>400 00 0/mu l), at a mean value of 511 000 (418 000-638 000)/mu l. The platel et count decreased more slowly than the inflammatory parameters. On av erage the platelet count returned to normal on the 14th day. Ischaemic complications developed in three patients (visual disturbances, blind ness, cardiac arrhythmias, neurological deficits): all had a high plat elet count (462 000-524 000/mu l). Conclusions: Thrombocytosis can ser ve as an additional criterion in the diagnosis and follow-up of polymy algia rheumatica, An association with ischaemic complications is espec ially likely in the elderly, in case of immobility and if there is evi dence of giant-cell arteritis. Treatment with platelet aggregation inh ibitors should be considered.