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Drugs & Aging Nov 2019Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most... (Review)
Review
Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most common inflammatory rheumatic condition in this age group, after rheumatoid arthritis. Polymyalgia rheumatica can occur independently or in association with giant cell arteritis, which is the most common form of primary vasculitis. The diagnosis of polymyalgia rheumatica is usually based on clinical presentation and increase of inflammatory markers. There are no pathognomonic findings that can confirm the diagnosis. However, different imaging techniques, especially ultrasonography, can assist in the identification of polymyalgia rheumatica. Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatica, but they might be associated with different adverse events. A subgroup of patients presents with a refractory disease course and, in these cases, adding methotrexate as a steroid-sparing agent could be useful. In this review, we summarise the latest findings regarding the pathogenesis, diagnosis and management of polymyalgia rheumatica and try to highlight the possible pitfalls, especially in elderly patients.
Topics: Aged; Antirheumatic Agents; Biological Products; Diagnosis, Differential; Giant Cell Arteritis; Glucocorticoids; Humans; Polymyalgia Rheumatica
PubMed: 31493201
DOI: 10.1007/s40266-019-00705-5 -
CMAJ : Canadian Medical Association... Nov 2021
Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Female; Giant Cell Arteritis; Glucocorticoids; Humans; Incidence; Male; Medical History Taking; Middle Aged; Polymyalgia Rheumatica; Prednisone
PubMed: 34810164
DOI: 10.1503/cmaj.210541 -
Annals of Internal Medicine May 2017This issue provides a clinical overview of polymyalgia rheumatica, focusing on risk factors, diagnosis, treatment, and practice improvement. The content of In the Clinic... (Review)
Review
This issue provides a clinical overview of polymyalgia rheumatica, focusing on risk factors, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
Topics: Diagnosis, Differential; Glucocorticoids; Humans; Immunosuppressive Agents; Patient Education as Topic; Polymyalgia Rheumatica; Prognosis; Risk Factors
PubMed: 28460395
DOI: 10.7326/AITC201705020 -
Lancet (London, England) Jan 2013Polymyalgia rheumatica is a chronic, inflammatory disorder of unknown cause that affects people over age 50 years. Classic symptoms include pain and long-term morning... (Review)
Review
Polymyalgia rheumatica is a chronic, inflammatory disorder of unknown cause that affects people over age 50 years. Classic symptoms include pain and long-term morning stiffness of the neck, shoulders, hips, upper arms, and thighs. Although markers of inflammation are often raised, no specific laboratory test exists for the disorder and the diagnosis is based on clinical assessment. Provisional classification criteria were published in April, 2012, by a collaborative initiative of the European League Against Rheumatism and the American College of Rheumatology. Several other disorders can mimic polymyalgia rheumatica. In particular, clinical manifestations can be difficult to differentiate from other forms of inflammatory arthritis such as spondyloarthritis and rheumatoid arthritis. Imaging studies such as ultrasonography and MRI typically show a predominantly periarticular inflammatory process. A subset of patients has an associated inflammatory vasculopathy affecting large arteries (giant cell arteritis). The standard treatment is low-dose glucocorticoids, which provide symptomatic relief for most patients. However, disease relapses are common, and treatment with glucocorticoids is associated with substantial morbidity. Improved understanding of disease pathogenesis might allow for more targeted immunotherapy.
Topics: Diagnosis, Differential; Humans; Polymyalgia Rheumatica; Prognosis
PubMed: 23051717
DOI: 10.1016/S0140-6736(12)60680-1 -
BMJ (Clinical Research Ed.) Dec 2013
Review
Topics: Algorithms; Glucocorticoids; Humans; Polymyalgia Rheumatica
PubMed: 24301266
DOI: 10.1136/bmj.f6937 -
Expert Opinion on Biological Therapy 2023Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of the elderly, treated mainly with systemic corticosteroids. The frequency of side effects of steroids... (Review)
Review
INTRODUCTION
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disease of the elderly, treated mainly with systemic corticosteroids. The frequency of side effects of steroids is high in this aged population and increased due to comorbidities. The use of biological treatments could be of interest in this condition.
AREAS COVERED
This review takes into account literature data from the PubMed and clinical trial databases concerning the results of the use of biological treatments in PMR, in terms of efficacy and safety of these treatments.
EXPERT OPINION
Current data do not allow us to identify any particular efficacy of the various anti-TNF agents used in the treatment of PMR. Anti-interleukin 6 agents (tocilizumab, sarilumab) have shown consistent efficacy results, suggesting a particularly interesting steroid-sparing effect in the population under consideration. The safety profile appears acceptable. Other biologic targeted treatments are currently being evaluated. Anti-interleukin-6 agents may well have a place in the therapeutic strategy for PMR, particularly for patients with steroid-resistant disease or at high risk of complications of corticosteroid therapy.
Topics: Aged; Humans; Polymyalgia Rheumatica; Tumor Necrosis Factor Inhibitors; Giant Cell Arteritis; Glucocorticoids; Biological Therapy; Steroids
PubMed: 37994867
DOI: 10.1080/14712598.2023.2287097 -
Rheumatic Diseases Clinics of North... May 1990Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle.... (Review)
Review
Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle. The aching should be present for greater than one month. Polymyalgia rheumatica may be more common than reported. The etiology remains unknown. There is generally little found pathologically in this disease. The physical examination is often not impressive. Synovitis may be a main contributing factor to many of the symptoms seen in patients with polymyalgia rheumatica. Symptoms often do not correlate with physical findings. Polymyalgia rheumatica must be differentiated from many conditions since the diagnosis remains entirely clinical. Osteoarthritis, flu syndromes, inflammatory myopathies, fibromyalgia, and depression all have features that may mimic polymyalgia rheumatica. Malignancies and infections may also be difficult to separate from polymyalgia rheumatica. Polymyalgia rheumatica may also be extremely difficult to differentiate from seronegative rheumatoid arthritis in patients older than 50 years. Although some patients with polymyalgia rheumatica have underlying giant cell arteritis, the majority apparently do not. The distinction between polymyalgia rheumatica and giant cell arteritis cannot be made on the basis of laboratory studies and relies solely on clinical symptoms and physical findings. Although nonsteroidal antiinflammatory medications may control symptoms in patients with mild disease, most patients with polymyalgia rheumatica require low-dose corticosteroids. The tapering schedule for the corticosteroids is contingent upon the response of symptoms and laboratory parameters. Polymyalgia rheumatica usually follows a benign course with almost complete response to an adequate treatment program. Recently, there have been several studies suggesting that the course of polymyalgia rheumatica may not be as short and simple as once proposed. Nevertheless, many patients may be completely weaned from corticosteroids. Other agents have been used in this disease, but for the most part their use remains somewhat controversial. Patients must be monitored carefully. Most patients do well, and treatment is effective.
Topics: Aged; Diagnosis, Differential; Humans; Middle Aged; Polymyalgia Rheumatica
PubMed: 2189154
DOI: No ID Found -
BMJ (Clinical Research Ed.) Apr 2008
Review
Topics: Adrenal Cortex Hormones; Humans; Polymyalgia Rheumatica; Prednisolone
PubMed: 18390527
DOI: 10.1136/bmj.39514.653588.80 -
Seminars in Arthritis and Rheumatism 1972
Review
Topics: Adult; Aged; Arteritis; Biopsy; Blood Sedimentation; Diagnosis, Differential; Female; Giant Cell Arteritis; Humans; Male; Middle Aged; Polymyalgia Rheumatica; Prednisone; Radiography; Vision Disorders
PubMed: 4563397
DOI: 10.1016/0049-0172(72)90003-0 -
Clinical Orthopaedics and Related... 1968
Review
Topics: Aged; Diagnosis, Differential; Female; Glucocorticoids; Humans; Myositis; Polymyalgia Rheumatica; Prednisone
PubMed: 4877807
DOI: No ID Found