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Clinical and Experimental Rheumatology Apr 2023
Topics: Humans; Polymyalgia Rheumatica; Giant Cell Arteritis; Fluorodeoxyglucose F18
PubMed: 36995322
DOI: 10.55563/clinexprheumatol/3bozph -
FP Essentials Jul 2020Polymyalgia rheumatica (PMR) is a chronic systemic inflammatory disease that is common in individuals older than 70 years. Classic symptoms of PMR include pain in the...
Polymyalgia rheumatica (PMR) is a chronic systemic inflammatory disease that is common in individuals older than 70 years. Classic symptoms of PMR include pain in the neck, pelvic girdle, and shoulders. Morning stiffness that lasts at least 30 minutes is typical. Glucocorticoids are the mainstay of PMR management, and prednisone 12.5 to 25 mg/day or equivalent is recommended. Giant cell arteritis is a comorbidity of PMR. Dermatomyositis is a rare, idiopathic inflammatory myopathy characterized by erythematous skin lesions and inflammation of skeletal muscles. Dermatomyositis manifests as proximal muscle weakness and fatigue that occurs when patients rise from a seated position, walk, climb stairs, or lift objects. It is a systemic condition and also may affect joints, the esophagus, and lungs. Prednisone is started at a dose of 60 mg/day and then tapered slowly, based on response, to prevent recurrence. Dermatomyositis may be associated with malignancy.
Topics: Dermatomyositis; Diagnosis, Differential; Giant Cell Arteritis; Glucocorticoids; Humans; Polymyalgia Rheumatica; Prednisone
PubMed: 32640151
DOI: No ID Found -
Rheumatic Diseases Clinics of North... May 2024Polymyalgia rheumatica (PMR) immune-related adverse events (ICI-PMRs) represent a novel, distinct entity, despite many clinical, laboratory, and imaging similarities to... (Review)
Review
Polymyalgia rheumatica (PMR) immune-related adverse events (ICI-PMRs) represent a novel, distinct entity, despite many clinical, laboratory, and imaging similarities to classical PMR. Important questions remain in differentiating ICI-PMR from classical PMR, as well as other immune-related adverse events and PMR mimics. Despite this, ICI-PMR currently takes treatment cues from classical PMR, albeit with considerations relevant to cancer immunotherapy. Comparisons between ICI-PMR and classical PMR may provide further bidirectional insights, especially given that important questions remain unanswered about both diseases. The cause of classical PMR remains poorly understood, and ICI-PMR may represent a model of induced PMR, with important therapeutic implications.
Topics: Polymyalgia Rheumatica; Humans; Immune Checkpoint Inhibitors
PubMed: 38670724
DOI: 10.1016/j.rdc.2024.02.001 -
American Family Physician Oct 2022Polymyalgia rheumatica and giant cell arteritis are inflammatory conditions that occur predominantly in people 50 years and older, with peak incidence at 70 to 75 years...
Polymyalgia rheumatica and giant cell arteritis are inflammatory conditions that occur predominantly in people 50 years and older, with peak incidence at 70 to 75 years of age. Polymyalgia rheumatica is more common and typically presents with constitutional symptoms, proximal muscle pain, and elevated inflammatory markers. Diagnosis of polymyalgia rheumatica is clinical, consisting of at least two weeks of proximal muscle pain, constitutional symptoms, and elevated erythrocyte sedimentation rate or C-reactive protein. Treatment of polymyalgia rheumatica includes moderate-dose glucocorticoids with a prolonged taper. Giant cell arteritis, also known as temporal arteritis, usually presents with new-onset headache, visual disturbances or changes, constitutional symptoms, scalp tenderness, and temporal artery symptoms. Inflammatory markers are markedly elevated. Temporal arterial biopsy should be used for diagnosis. However, color duplex ultrasonography, magnetic resonance imaging, and fluorodeoxyglucose positron emission tomography may be helpful when biopsy is negative or unavailable. All patients with suspected giant cell arteritis should receive empiric high-dose glucocorticoids because the condition may lead to blindness if untreated. Tocilizumab is approved by the U.S. Food and Drug Administration for giant cell arteritis and should be considered in addition to glucocorticoids for initial therapy. Polymyalgia rheumatica and giant cell arteritis respond quickly to appropriate dosing of glucocorticoids but typically require prolonged treatment and have high rates of relapse; therefore, monitoring for glucocorticoid-related adverse effects and symptoms of relapse is necessary. Methotrexate may be considered as an adjunct to glucocorticoids in patients with polymyalgia rheumatica or giant cell arteritis who are at high risk of relapse.
Topics: Humans; Polymyalgia Rheumatica; Giant Cell Arteritis; Glucocorticoids; Methotrexate; C-Reactive Protein; Myalgia; Recurrence
PubMed: 36260899
DOI: No ID Found -
Annals of the Rheumatic Diseases May 2023
Topics: Humans; Polymyalgia Rheumatica; Giant Cell Arteritis; Piperidines; Pyrimidines; Glucocorticoids
PubMed: 36604153
DOI: 10.1136/ard-2022-223562 -
Expert Review of Clinical Immunology 2023Polymyalgia rheumatica is a common inflammatory rheumatic disease in subjects aged 50 years or older and classically presents with shoulder and/or pelvic girdle pain... (Review)
Review
INTRODUCTION
Polymyalgia rheumatica is a common inflammatory rheumatic disease in subjects aged 50 years or older and classically presents with shoulder and/or pelvic girdle pain and prolonged morning stiffness. Glucocorticoids represent the standard of treatment; glucocorticoid therapy is usually required for 1-2 years and often results in significant glucocorticoid-related side effects, especially in the elderly.
AREAS COVERED
In this review, we aimed to provide a comprehensive overview of the management of polymyalgia rheumatica, with a particular focus on adjunctive therapies to the standard glucocorticoid treatment.
EXPERT OPINION
Given the high frequency of disease relapses (one-third of patients) and the adverse events related to prolonged glucocorticoid use, the need for glucocorticoid-sparing agents remains an important issue in the management of polymyalgia rheumatica. In selected patients, who are at risk for glucocorticoid-related side effects or in those with glucocorticoid-refractory disease, the addition of a glucocorticoid-sparing agent, either a synthetic or biologic disease-modifying anti-rheumatic drug, may represent a reasonable and effective therapeutic approach.
Topics: Aged; Humans; Polymyalgia Rheumatica; Glucocorticoids; Giant Cell Arteritis; Antirheumatic Agents; Steroids
PubMed: 37480289
DOI: 10.1080/1744666X.2023.2240519 -
Primary Care Jun 2018Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory diseases of adults aged 50 years or older. The diagnosis of PMR is based on morning... (Review)
Review
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are related inflammatory diseases of adults aged 50 years or older. The diagnosis of PMR is based on morning stiffness, proximal shoulder and pelvic girdle pain, and functional impairment. GCA is characterized by headache, jaw claudication, and visual disturbances. Constitutional symptoms and elevated inflammatory markers are common to both conditions. Temporal artery biopsy remains the gold standard for diagnosis of GCA. Glucocorticoids are the cornerstone of therapy, with tapering regimens individualized to the patient. Prompt diagnosis and treatment are essential to avert vision loss in GCA. Tocilizumab increases remission rates in GCA.
Topics: Aged; Drug Administration Schedule; Giant Cell Arteritis; Glucocorticoids; Humans; Middle Aged; Polymyalgia Rheumatica; Prednisone; Primary Health Care
PubMed: 29759126
DOI: 10.1016/j.pop.2018.02.007 -
MMW Fortschritte Der Medizin Apr 2022
Topics: Giant Cell Arteritis; Humans; Polymyalgia Rheumatica
PubMed: 35391672
DOI: 10.1007/s15006-022-1053-2 -
Nederlands Tijdschrift Voor Geneeskunde 2017- Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder in which inflammation markers, both erythrocyte sedimentation rate (ESR) and CRP values, are often... (Review)
Review
- Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder in which inflammation markers, both erythrocyte sedimentation rate (ESR) and CRP values, are often elevated. However, a non-abnormal ESR or CRP value does not preclude the diagnosis.- PMR is an arbitrary diagnosis and presents both diagnostic and therapeutic challenges.- Imaging diagnostics, such as echography, MRI or FDG-PET/CT, may potentially be applied more frequently as a second-line investigation when there is doubt concerning the diagnosis. Currently these additional imaging techniques are not applied in first line diagnostics.- Glucocorticoids remain the cornerstone treatment for polymyalgia rheumatica. Often patients react swiftly to this, but in 29-45% of cases an effect is only observed 3-4 weeks later. The treatment course typically lasts 1-3 years.- More research has been conducted into potential glucocorticoid-sparing treatments. Most of the scientific evidence concerns the effectiveness of methotrexate; there is some evidence regarding the effectiveness of azathioprine and leflunomide. Tocilizumab, an IL-6 receptor inhibitor, has shown promise as a treatment, but further evidence is required.
Topics: Diagnosis, Differential; Giant Cell Arteritis; Glucocorticoids; Humans; Methotrexate; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography
PubMed: 29192568
DOI: No ID Found -
Internal Medicine Journal Nov 2015Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder of unknown cause characterised by the subacute onset of shoulder and pelvic girdle pain, and early... (Review)
Review
Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder of unknown cause characterised by the subacute onset of shoulder and pelvic girdle pain, and early morning stiffness in men and women over the age of 50 years. Due to the lack of a gold standard investigation, diagnosis is based on a clinical construct and laboratory evidence of inflammation. Heterogeneity in the clinical presentation and disease course of PMR has long been recognised. Aside from the evolution of alternative diagnoses, such as late-onset rheumatoid arthritis, concomitant giant cell arteritis is also recognised in 16-21% of cases. In 2012, revised classification criteria were released by the European League Against Rheumatism and American College of Rheumatology in order to identify a more homogeneous population upon which future studies could be based. In this article, we aim to provide an updated perspective on the pathogenesis and diagnosis of PMR, with particular focus on imaging modalities, such as ultrasound and whole body positron emission tomography/computed tomography, which have advanced our current understanding of this disease. Future treatment directions, based on recognition of the key cytokines involved in PMR, will also be explored.
Topics: Diagnosis, Differential; Giant Cell Arteritis; Glucocorticoids; Humans; Polymyalgia Rheumatica
PubMed: 26036315
DOI: 10.1111/imj.12823