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South Dakota Medicine : the Journal of... Mar 2016Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) are two rheumatological conditions with significant overlap that typically affect the older white population.... (Review)
Review
Polymyalgia rheumatic (PMR) and giant cell arteritis (GCA) are two rheumatological conditions with significant overlap that typically affect the older white population. PMR is the most common inflammatory rheumatic disease of the elderly and shares many pathogenetic and epidemiological features with GCA. Diagnosis is made primarily on clinical grounds with supporting laboratory evidence. Typical symptoms of PMR are bilateral aching of the shoulders and pelvic girdle associated with stiffness. PMR is associated with GCA and is considered to be on a disease continuum. Approximately half of patients diagnosed with GCA have already been or will be diagnosed with PMR. GCA is the most common vasculitis in adults and affects medium and large arteries and can result in blindness if untreated. Clinically it may present either gradually or abruptly. The most common presentation is headache with an aching pain classically localizing to the temporal region of moderate intensity which responds poorly to analgesics. Patients may also experience jaw or tongue claudication with weakening or pain in the muscles of mastication that is relieved by rest. The temporal artery may exhibit palpable beading, diminished pulses, bruits and tenderness.
Topics: Aged; Aged, 80 and over; Blindness; Diagnosis, Differential; Giant Cell Arteritis; Humans; Middle Aged; Pain; Polymyalgia Rheumatica
PubMed: 27156261
DOI: No ID Found -
Rheumatic Diseases Clinics of North... Feb 2016Diagnosis of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) is based on typical clinical, histologic, and laboratory features. Ultrasonographic imaging in... (Review)
Review
Diagnosis of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) is based on typical clinical, histologic, and laboratory features. Ultrasonographic imaging in PMR with assessment especially of subdeltoid bursitis can aid in diagnosis and in following response to treatment. In GCA, diagnosis and disease activity are supported with ultrasonographic, MRI, or [(18)F]fluorodeoxyglucose PET evaluation of large vessels. Glucocorticoids are the primary therapy for PMR and GCA. Methotrexate may be used in patients at high risk for glucocorticoid adverse effects and patients with frequent relapse or needing protracted therapy. Other therapeutic approaches including interleukin 6 antagonists are under evaluation.
Topics: Disease Management; Giant Cell Arteritis; Glucocorticoids; Humans; Immunosuppressive Agents; Methotrexate; Polymyalgia Rheumatica; Shoulder Joint; Temporal Arteries; Ultrasonography
PubMed: 26611552
DOI: 10.1016/j.rdc.2015.08.009 -
International Journal of Environmental... Jan 2023Elderly-onset rheumatoid arthritis (EORA) is prevalent among older patients, and its incidence is increasing due to aging societies. However, differentiating between... (Review)
Review
Elderly-onset rheumatoid arthritis (EORA) is prevalent among older patients, and its incidence is increasing due to aging societies. However, differentiating between EORA and polymyalgia rheumatica (PMR) is challenging for clinicians and hinders the initiation of effective treatment for rheumatoid arthritis among older generations, thereby allowing its progression. Therefore, we conducted a qualitative synthesis of narrative reviews via meta-ethnography regarding seronegative EORA diagnosis to clarify the methods to differentiate seronegative EORA from PMR. Three databases (PubMed, EMBASE, and Web of Science) were searched for relevant reviews published between January 2011 and October 2022. The extracted articles were synthesized using meta-ethnography, and 185 studies were selected following the protocol. Seven reviews were analyzed, and four themes and nine concepts were identified. The four themes included difficulty in differentiation, mandatory follow-up, and factors favoring rheumatoid arthritis and those favoring PMR. Factors favoring seronegative EORA and PMR should be considered for effective diagnosis and prompt initiation of disease-modifying anti-rheumatic drugs. Mandatory and long follow-ups of suspected patients are essential for differentiating the two diseases. The attitude of rheumatologists toward tentatively diagnosing seronegative EORA and flexibly modifying their hypotheses based on new or altered symptoms can aid in effective management and avoiding misdiagnosis.
Topics: Humans; Aged; Polymyalgia Rheumatica; Arthritis, Rheumatoid
PubMed: 36767155
DOI: 10.3390/ijerph20031789 -
Current Rheumatology Reports Feb 2015Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two closely related diseases in people aged 50 years and older, which are more frequently observed in... (Review)
Review
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are two closely related diseases in people aged 50 years and older, which are more frequently observed in Western countries. Despite being common entities, concern still exists about the epidemiology, pathogenesis, and diagnosis of both entities. New imaging techniques, such as 18 fluorodeoxyglucose-positron emission tomography, have proved to be useful in detecting large-vessel involvement in GCA. Corticosteroids are the cornerstone of the therapy in GCA and PMR. Relapses are frequent in these conditions. Unlike methotrexate and tumor necrosis factor-α antagonists, anti-interleukin-6 receptor therapy appears to be useful in patients with GCA and PMR who are refractory to corticosteroids. This review summarizes recent studies on GCA and PMR.
Topics: Giant Cell Arteritis; Glucocorticoids; Humans; Polymyalgia Rheumatica; Treatment Outcome
PubMed: 25618572
DOI: 10.1007/s11926-014-0480-1 -
Current Rheumatology Reports Aug 2015Remitting seronegative symmetrical synovitis with pitting edema or RS3PE is a rare elderly-onset rheumatic syndrome. Although there are overlapping clinical... (Review)
Review
Remitting seronegative symmetrical synovitis with pitting edema or RS3PE is a rare elderly-onset rheumatic syndrome. Although there are overlapping clinical manifestations between RS3PE, elderly-onset rheumatoid arthritis, and polymyalgia rheumatica, RS3PE has distinct characteristics. RS3PE can be associated with neoplasia and various rheumatic conditions, suggesting that it may be heterogeneous, and is considered as a paraneoplastic rheumatic disease. The pathogenesis of RS3PE may involve vascular endothelial growth factor and infection in RS3PE based upon limited data. Patients with RS3PE without concomitant malignancy respond well to small doses of glucocorticoids and carry good prognosis.
Topics: Arthritis, Rheumatoid; Biomedical Research; Diagnosis, Differential; Edema; Glucocorticoids; Humans; Paraneoplastic Syndromes; Polymyalgia Rheumatica; Prognosis; Syndrome; Synovitis
PubMed: 26113011
DOI: 10.1007/s11926-015-0525-0 -
RMD Open Mar 2024The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs.
METHOD
Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots.
RESULTS
A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time.
CONCLUSION
The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used.
TRIAL REGISTRATION NUMBER
NTC02908217.
Topics: Humans; Polymyalgia Rheumatica; Giant Cell Arteritis; Glucocorticoids; C-Reactive Protein; Blood Sedimentation
PubMed: 38490696
DOI: 10.1136/rmdopen-2023-003741 -
Neurology India 2016Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to an increased risk of cerebrovascular accident... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, have been linked to an increased risk of cerebrovascular accident (CVA), but the data on polymyalgia rheumatica (PMR) remains unclear.
MATERIALS AND METHODS
We conducted a systematic review and meta-analysis of observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio comparing the risk of CVA in patients with PMR versus non-PMR controls. Pooled risk ratio and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method of DerSimonian and Laird.
RESULTS
Three retrospective cohort studies and one cross-sectional study were identified and included in the data analysis. We found a significantly elevated CVA risk in patients with PMR, with the pooled risk ratio of 1.87 (95% CI, 1.43-2.43). The statistical heterogeneity was high, with an I2 of 91%.
CONCLUSIONS
Our study demonstrated a statistically significantly increased CVA risk among patients with PMR.
Topics: Humans; Observational Studies as Topic; Polymyalgia Rheumatica; Risk Factors; Stroke
PubMed: 27625227
DOI: 10.4103/0028-3886.190273 -
Expert Review of Clinical Immunology Oct 2016Polymyalgia rheumatica is one of the most common rheumatic inflammatory disorders in people older than 50 years characterized by aching and prolonged morning stiffness... (Review)
Review
INTRODUCTION
Polymyalgia rheumatica is one of the most common rheumatic inflammatory disorders in people older than 50 years characterized by aching and prolonged morning stiffness in the shoulder and pelvic girdle and neck..
AREAS COVERED
In this review, we will focus on recent advances on the diagnosis and management of PMR. Expert commentary: Controversy exist whether PMR represent a single entity disease or is an umbrella term that comprises a clinical presentation common to a range of related conditions (polymyalgic syndrome). To date there are no specific diagnostic tests, and the diagnosis remains clinical, although ultrasonography, positron emission tomography scan and the recent ACR/EULAR classification criteria may help to confirm the clinical diagnosis. A step-wise process for the diagnosis of PMR has been proposed. Low-dose steroids are highly effective in the majority of patients and remain the mainstay of treatment, but relapses occur in about 50% of patients and glucocorticoid related adverse event are common. The steroid sparing effects of the immunosuppressive treatment evaluated to date are unclear.
Topics: Algorithms; Animals; Antibodies, Monoclonal, Humanized; Biomarkers; Diagnosis, Differential; Humans; Immunotherapy; Interleukin-6; Polymyalgia Rheumatica; Positron-Emission Tomography; Steroids; Ultrasonography
PubMed: 27079756
DOI: 10.1080/1744666X.2016.1178572 -
Rheumatology International May 2023Polymyalgia rheumatica (PMR) is an inflammatory joint disease in patients over 50 years of age with pain and prolonged morning stiffness in the shoulder and hip girdles...
Polymyalgia rheumatica (PMR) is an inflammatory joint disease in patients over 50 years of age with pain and prolonged morning stiffness in the shoulder and hip girdles and neck. The lack of specific clinical findings, laboratory signs, biomarker and established imaging methods makes it difficult to diagnose patients with this disease. The aim of the systematic review is to present the literature data on the use of imaging methods for early diagnosis, assessment of disease activity and therapeutic response in PMR. At the same time, the advantages, disadvantages and contraindications of each method are considered. A literature search was carried out in PubMed and Scopus up to June 2022. Studies were selected that met the following criteria: (1) English language publications in peer-reviewed journals, (2) cohort or case-control studies and a series of more than five clinical cases, (3) studies of newly diagnosed or suspected PMR patients according to classification criteria or expert opinion, (4) imaging evaluation of articular, extraarticular and vascular impairment in PMR. Out of a total of 1431 publications, 61 articles were selected, which differed in the imaging techniques used: radiography (5), scintigraphy (4), magnetic resonance imaging (14), PET/CT (14) and ultrasound (24). Prevalence of extraarticular involvement (tendons, entheses and bursae) was identified in patients with PMR. In a significant number of cases, subclinical vasculitis of the large vessels was found, confirming the common pathogenetic pathways of the two diseases. The diagnostic, therapeutic and prognostic potential of imaging methods in PMR has been relatively poorly studied and remains to be clarified.
Topics: Humans; Middle Aged; Polymyalgia Rheumatica; Positron Emission Tomography Computed Tomography; Giant Cell Arteritis; Pain; Ultrasonography
PubMed: 36853338
DOI: 10.1007/s00296-023-05284-8 -
Rheumatology International Jan 2017Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, are associated with an increased risk of coronary artery disease... (Meta-Analysis)
Meta-Analysis Review
Several chronic inflammatory disorders, such as rheumatoid arthritis and systemic lupus erythematosus, are associated with an increased risk of coronary artery disease (CAD) as a result of accelerated atherosclerosis. However, the data on CAD risk of polymyalgia rheumatica (PMR), one of the most common chronic inflammatory disorders in older adults, remain unclear due to limited number of epidemiological studies. To further investigate this possible association, this systematic review and meta-analysis of observational studies was performed to compare the risk of CAD in patients with PMR versus subjects without it. Published studies indexed in MEDLINE and EMBASE were searched from inception to April 2016 using the terms "polymyalgia rheumatica" combined with the terms for CAD. The inclusion criteria were: (1) observational studies published as original studies to evaluate the risk of CAD among patients with PMR; (2) published odds ratios, relative risk or hazard ratio or standardized incidence ratio with 95 % confidence intervals (CI) in the studies; and (3) subjects without PMR were used as comparators in cohort studies and cross-sectional studies, while subjects without CAD were used as comparators in case-control studies. Point estimates and standard errors were extracted from individual studies and were combined by the generic inverse variance method of DerSimonian and Laird. Four studies with 34,569 patients with PMR were identified and included in this meta-analysis. The pooled risk ratio of CAD in patients with PMR was 1.72 (95 % CI 1.21-2.45). The statistical heterogeneity of this meta-analysis was high with an I of 97 %.
Topics: Coronary Artery Disease; Humans; Incidence; Polymyalgia Rheumatica; Risk
PubMed: 27577940
DOI: 10.1007/s00296-016-3557-5