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Reumatismo Mar 2018Polymyalgia rheumatica (PMR) is a chronic, inflammatory disorder of unknown cause clinically characterized by pain and prolonged morning stiffness affecting the... (Review)
Review
Polymyalgia rheumatica (PMR) is a chronic, inflammatory disorder of unknown cause clinically characterized by pain and prolonged morning stiffness affecting the shoulders and often the pelvic girdle and neck. Imaging has substantially contributed to defining PMR as a disease mainly involving extra-articular structures. This review article analyses the role of the different imaging techniques in the diagnosis and follow-up of patients with PMR with particular emphasis on the role of ultrasound, PET/CT and MRI.
Topics: Aged; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Sensitivity and Specificity; Ultrasonography
PubMed: 29589403
DOI: 10.4081/reumatismo.2018.1040 -
JAMA Sep 2020
Review
Topics: Antibodies, Monoclonal, Humanized; Giant Cell Arteritis; Glucocorticoids; Humans; Immunosuppressive Agents; Methotrexate; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography
PubMed: 32897333
DOI: 10.1001/jama.2020.10155 -
Reumatismo Mar 2018Polymyalgia rheumatica (PMR) is the commonest inflammatory rheumatic disease affecting older people. The current mainstay of treatment is long-term oral glucocorticoid... (Review)
Review
Polymyalgia rheumatica (PMR) is the commonest inflammatory rheumatic disease affecting older people. The current mainstay of treatment is long-term oral glucocorticoid therapy. Management of these patients in clinical practice is often complicated by the presence of comorbidity. Comorbidity might be due to shared risk factors such as age, sex, or genetic background; to the presence of the disease itself; or to adverse effects of glucocorticoid therapy. Cardiovascular disease, osteoporosis/fracture, metabolic and ocular comorbidity are of particular interest to clinicians because of their relationship to glucocorticoid therapy and the relevance to clinical treatment decisions regarding glucocorticoid tapering. Patients at high risk of exacerbation of comorbidity by glucocorticoid therapy may be considered for adjunctive steroid-sparing therapies and thus may need specialist management. From a public health perspective, with the ageing population the prevalence of PMR is predicted to increase; accurate data on comorbidity will be needed for planning and delivery of healthcare services.
Topics: Aged; Cardiovascular Diseases; Comorbidity; Eye Diseases; Glucocorticoids; Humans; Metabolic Diseases; Neoplasms; Osteoporosis; Paraneoplastic Syndromes; Polymyalgia Rheumatica; Prevalence; Risk Factors; United Kingdom
PubMed: 29589401
DOI: 10.4081/reumatismo.2018.1039 -
Radiologic Technology Mar 2021Polymyalgia rheumatica (PMR) is an inflammatory condition that occurs in older adults. Its cause is unclear but might be autoimmune, autoinflammatory, environmental, or...
Polymyalgia rheumatica (PMR) is an inflammatory condition that occurs in older adults. Its cause is unclear but might be autoimmune, autoinflammatory, environmental, or genetic. Patients with PMR have proximal joint pain and stiffness that limit mobility and decrease quality of life. Diagnosis is based on clinical symptoms and blood test results. However, blood tests often are inconclusive, and PMR symptoms overlap those of several other conditions. Medical imaging helps confirm and clarify diagnosis, assess response to treatment, and evaluate for relapses. Many patients respond to long-term, low-dosage oral glucocorticoids. This article describes the epidemiology, manifestations, diagnosis, and treatment options for PMR.
Topics: Diagnosis, Differential; Giant Cell Arteritis; Glucocorticoids; Humans; Polymyalgia Rheumatica; Quality of Life
PubMed: 33653927
DOI: No ID Found -
Biochemical Pharmacology Jul 2019Polymyalgia rheumatica (PMR) is an inflammatory disease characterized by bilateral pain involving predominantly the shoulders and proximal aspects of the arms and less... (Review)
Review
Polymyalgia rheumatica (PMR) is an inflammatory disease characterized by bilateral pain involving predominantly the shoulders and proximal aspects of the arms and less commonly the neck and the pelvic girdle. This review discusses briefly the main epidemiological data and clinical features of this condition. Especial attention is paid in the management of the disease. For this reason, both the classic management and the impact of new therapies are discussed in depth. In general, patients with PMR experience a rapid response to 12.5-25 mg/prednisone/day in less than a week. Patients with poor response to glucocorticoids or with relapsing disease require other therapies aimed mainly to spare glucocorticoids. Among them, methotrexate is the most commonly used. Nevertheless, different studies indicate that this agent yields only a modest effect. Biologic therapies against the main cytokines involved in the pathogenesis of the disease have been used in refractory patients. However, randomized controlled trials do not support the use of anti-tumor necrosis factor agents in PMR. In contrast, several case series and retrospective studies highlight the efficacy of the anti-interleukin-6 receptor tocilizumab in PMR. Nonetheless, controlled trials are needed to fully establish the beneficial effect of this agent. The potential favorable effect of the Janus-kinase inhibitors and new anti-interleukin-6 antagonists remains to be determined.
Topics: Glucocorticoids; Humans; Janus Kinases; Methotrexate; Polymyalgia Rheumatica; Receptors, Interleukin-6
PubMed: 30904473
DOI: 10.1016/j.bcp.2019.03.027 -
Best Practice & Research. Clinical... Dec 2022For decades, aside from prednisone and the occasional use of immune suppressive drugs such as methotrexate, there was little to offer patients with polymyalgia... (Review)
Review
For decades, aside from prednisone and the occasional use of immune suppressive drugs such as methotrexate, there was little to offer patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). However, there is a great interest in various steroid sparing treatments in both these conditions. This paper aims to provide an overview of our current knowledge of PMR and GCA, examining their similarities and distinctions in terms of clinical presentation, diagnosis, and treatment, with emphasis placed on reviewing recent and ongoing research efforts on emerging treatment. Multiple recent and ongoing clinical trials are demonstrating new therapeutics that will provide benefit and contribute to the evolution of clinical guidelines and standard of care for patients with GCA and/or PMR.
Topics: Humans; Polymyalgia Rheumatica; Giant Cell Arteritis; Methotrexate; Glucocorticoids
PubMed: 36907732
DOI: 10.1016/j.berh.2023.101822 -
Rheumatology International Jan 2021Immune checkpoint inhibitors (ICI) associate with a wide range of immune-related adverse events (Ir-AE), including musculoskeletal manifestations. We aimed at... (Review)
Review
Immune checkpoint inhibitors (ICI) associate with a wide range of immune-related adverse events (Ir-AE), including musculoskeletal manifestations. We aimed at identifying all studies reporting musculoskeletal Ir-AE. An electronic (Medline, Scopus and Web of Science) search was performed using two sets of key words. The first set consisted of: arthritis, musculoskeletal, polymyalgia rheumatica and myositis. The second set consisted of: anti-PD-1, anti-PD-L1, anti-CTLA-4, ipilimumab, tremelimumab, pembrolizumab, nivolumab, atezolizumab, avelumab and durvalumab. We identified 3 prospective studies, 17 retrospective studies and 4 case series reporting 363 patients in total. Combined data from all three prospective studies provide a prevalence rate of 6.13%. Most patients were males (59.68%) and the vast majority (73%) were on programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) inhibitors. Most studies report a median time of ≤ 12 weeks from first ICI administration to symptom onset. The main clinical phenotypes reported were: (a) inflammatory arthritis (57.57%), (b) myositis (14.04%) and (c) polymyalgia rheumatica (PMR) (12.12%). A total of 256 patients required steroids (70.52%) and 67 patients (18.45%) were treated with DMARDs. Positive auto-antibodies and family history of any autoimmune disease were present in 18.48% and 19.04% of cases, respectively. Only a few patients (19%) had to discontinue treatment due to musculoskeletal Ir-AE. Two prospective studies show that significantly more patients with musculoskeletal Ir-AE exhibit a favorable oncologic response compared to patients not exhibiting such manifestations whereas retrospective studies show that 77.22% of patients with musculoskeletal Ir-AE have a good tumor response. One out of 15 patients treated with ICI will develop musculoskeletal Ir-AE; in most cases the severity of these manifestations is mild/moderate and usually ICI may be continued. Rheumatologists should familiarize with this new clinical entity and develop relevant therapeutic algorithms.
Topics: Arthritis, Rheumatoid; Female; Humans; Immune Checkpoint Inhibitors; Immunosuppression Therapy; Male; Myositis; Polymyalgia Rheumatica; Prevalence
PubMed: 32743706
DOI: 10.1007/s00296-020-04665-7 -
Rheumatic Diseases Clinics of North... May 2022Immune checkpoint inhibitors activate the immune system to combat cancer. In doing so, however, they can cause immune-related adverse events (irAEs), including rheumatic... (Review)
Review
Immune checkpoint inhibitors activate the immune system to combat cancer. In doing so, however, they can cause immune-related adverse events (irAEs), including rheumatic syndromes, such as inflammatory arthritis, polymyalgia rheumatica, and myositis. This article reviews rheumatic irAEs that may be encountered in the general medicine practice and provides guidance to support prompt recognition, referral, and treatment of these patients.
Topics: Humans; Immune Checkpoint Inhibitors; Myositis; Neoplasms; Polymyalgia Rheumatica; Rheumatic Diseases
PubMed: 35400368
DOI: 10.1016/j.rdc.2022.02.002 -
Vnitrni Lekarstvi 2018Polymyalgia rheumatica is the most frequent inflammatory disease of people over 50 years of age. It mainly affects the Caucasian race and roughly 2-3 times as many...
Polymyalgia rheumatica is the most frequent inflammatory disease of people over 50 years of age. It mainly affects the Caucasian race and roughly 2-3 times as many women. From the viewpoint of etiology, polymyalgia rheumatica is a complex disease. Involved in its origin is genetic predisposition, factors of age and outer environment. 16-21 % of patients with polymyalgia rheumatica may at the same time have symptoms of giant cell arteritis. Diagnosis is made primarily on the basis of clinical symptoms and it is supported by the presence of laboratory signs of inflammation. There is no specific diagnostic test available for diagnosing polymyalgia rheumatica. In recent time modern imaging devices, e.g. ultrasonography or positron emission tomography, can be used in diagnosing the disease. In the past a number of diagnostic and classification criteria were established which may be used in diagnosing of polymyalgia rheumatica in general practice. The differential diagnostics of the disease is extensive. Before the treatment commencement it is necessary to rule out the presence of another disease with manifestations simulating polymyalgia rheumatica. The treatment strategy should draw on the current EULAR/ACR Recommendations for the treatment of polymyalgia rheumatica issued in 2015.Key words: polymyalgia rheumatica - positron emission tomography - prognosis - treatment - ultrasonography.
Topics: Diagnosis, Differential; Female; Humans; Inflammation; Middle Aged; Polymyalgia Rheumatica; Prognosis
PubMed: 29595283
DOI: No ID Found -
The Practitioner Dec 2016Polymyalgia rheumatica (PMR) is a common inflammatory condition of unknown aetiology with a prevalence of 1 in 133 in the over 50s, and a female to male ratio of 2:1.... (Review)
Review
Polymyalgia rheumatica (PMR) is a common inflammatory condition of unknown aetiology with a prevalence of 1 in 133 in the over 50s, and a female to male ratio of 2:1. Symptoms develop over a matter of weeks; typically bilateral shoulder or pelvic girdle pain and stiffness, that is worse in the mornings. Associated symptoms include low-grade fever, malaise, fatigue, low mood, poor appetite, and weight loss. There is no specific diagnostic test for PMR but the usual pattern is a commensurate rise in CRP and ESR. A small proportion of PMR patients will have normal inflammatory markers. PMR is associated with giant cell arteritis (GCA). Half of patients with GCA will have some PMR symptoms and up to one fifth of patients with PMR will have evidence of GCA. Other conditions that can mimic PMR include: rheumatic disease in the elderly e.g. rheumatoid arthritis; inflammatory muscle diseases; thyroid disease; malignancy; infection; bilateral shoulder capsulitis; osteoarthritis, Parkinsonism and depressive illness. At diagnosis and each follow-up visit it is imperative to consider the potential for associated GCA. The patient should be asked about headaches, jaw claudication and visual disturbance. If there is any suspicion of GCA, urgent discussion with the rheumatologist should take place that day.
Topics: Aged; Female; Giant Cell Arteritis; Glucocorticoids; Humans; Male; Middle Aged; Polymyalgia Rheumatica; Prednisone; Randomized Controlled Trials as Topic
PubMed: 29020715
DOI: No ID Found