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Orvosi Hetilap Jan 2016Polymyalgia rheumatica is an inflammatory musculoskeletal disorder of people aged 50 years or over, characterised by pain, aching and morning stiffness in the shoulder... (Review)
Review
Polymyalgia rheumatica is an inflammatory musculoskeletal disorder of people aged 50 years or over, characterised by pain, aching and morning stiffness in the shoulder girdle and often hip girdle and neck. Marked systemic inflammation and rapid response to corticosteroid therapy are characteristic features. Giant cell arteritis is a well-known association of polymyalgia rheumatica. Recent clinical evidence and scientific results in the field have provided new challenges for rheumatologists. Besides the aspecific - although characteristic - proximal syndrome, less well recognizable and more variable distal musculoskeletal manifestations were observed. Magnetic resonance and ultrasound studies showed mild, remitting and non-erosive synovitis, with dominating inflammation of the extraarticular synovial structures. As no pathognostic sign is known, the diagnosis of polymyalgia rheumatica is based on its differential diagnosis, differentiation from the polymyalgia mimics; particularly from elderly onset inflammatory arthritides, such as elderly onset rheumatoid arthritis and late onset seronegative spondylarthritis. In 2012 the international polymyalgia rheumatica work group under the guidance of the American College of Rheumatology and European League Against Rheumatism elaborated new classification criteria, the scoring algorythm of which is based on clinical symptoms, with ultrasonography increasing the specificity. Corticosteroids remain the cornerstone of the therapy of polymyalgia rheumatica. No effective steroid-sparing drug has been found to date. Corticosteroids are generally needed for 1-1.5 years, though some patients have a chronic-relapsing course and require corticosteroids for several years. Well known corticosteroid-related side effects (diabetes, hypertension, hyperlipidaemia and osteoporosis) cause significant morbidity and economic burden on the society. Novel therapeautic approaches are on trial. Early recognition of the disease, early start of corticosteroids and a well-defined course, prevention and management of side effects are everyday tasks for rheumatologists and family doctors. Knowledge of polymyalgia rheumatica is essential for all medical specialties.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Bursitis; Diagnosis, Differential; Drug Chronotherapy; Giant Cell Arteritis; History, 15th Century; History, 19th Century; History, 20th Century; Humans; Polymyalgia Rheumatica; Spondylarthritis
PubMed: 26708681
DOI: 10.1556/650.2016.30314 -
Recenti Progressi in Medicina May 1985
Review
Topics: Arteries; Arteritis; Arthritis, Rheumatoid; Diagnosis, Differential; Humans; Lupus Erythematosus, Systemic; Muscles; Polymyalgia Rheumatica
PubMed: 3895327
DOI: No ID Found -
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 -
Clinical Medicine (London, England) Aug 2013
Review
Topics: Anti-Inflammatory Agents; Disease Management; Disease Progression; Humans; Polymyalgia Rheumatica; Prognosis
PubMed: 23908514
DOI: 10.7861/clinmedicine.13-4-398 -
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 -
European Journal of Internal Medicine Oct 2013Polymyalgia rheumatica is an inflammatory disease of unknown etiology affecting individuals aged fifty years and older, mainly of Caucasian ethnicity. Polymyalgia... (Review)
Review
Polymyalgia rheumatica is an inflammatory disease of unknown etiology affecting individuals aged fifty years and older, mainly of Caucasian ethnicity. Polymyalgia rheumatica is associated with giant cell arteritis more frequently than expected by chance alone. In both conditions, females are affected two to three times more often than males. The clinical hallmark manifestations of polymyalgia rheumatica are aching and morning stiffness in the shoulder girdle and often in the pelvic girdle and neck. Serum inflammatory markers are typically elevated, while the most consistent abnormal finding on imaging studies is bursitis in the symptomatic areas. A dramatic response to glucocorticoids is characteristic of polymyalgia rheumatica. Many patients are able to discontinue glucocorticoids six months to two years after the onset of clinical symptoms, but some patients may require longstanding glucocorticoid treatment. Glucocorticoid-sparing agents may be helpful in patients with chronic relapsing courses and those at high risk of glucocorticoid-related adverse events.
Topics: Antirheumatic Agents; Chronic Disease; Diagnosis, Differential; Glucocorticoids; Humans; Polymyalgia Rheumatica; Secondary Prevention
PubMed: 23579169
DOI: 10.1016/j.ejim.2013.03.003 -
Clinics in Rheumatic Diseases Apr 1986
Review
Topics: Aged; Anti-Inflammatory Agents; Biopsy; Blood Cell Count; Blood Proteins; Blood Sedimentation; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Liver Function Tests; Male; Middle Aged; Polymyalgia Rheumatica; Prednisolone; Temporal Arteries
PubMed: 3522085
DOI: No ID Found -
Orvosi Hetilap Sep 2006Polymyalgia rheumatica is a disorder that affects people over 50 years of age. The etiology of the disease has not been hitherto clarified exactly. Its incidence among... (Review)
Review
Polymyalgia rheumatica is a disorder that affects people over 50 years of age. The etiology of the disease has not been hitherto clarified exactly. Its incidence among people over 50 is in the range of 0.1-0.5%. The incidence rate peaks in the age group of 60-70 years. It is also found in younger people, but far less frequently. The diagnosis is based primarily on locomotor complains--namely on pronounced pain, morning stiffness of the shoulder girdle, pelvic girdle and neck. Complaints relating to the arms and legs (such as muscular weakness, oedema, tendonitis etc.) are also observed, however, in one third of the cases. The diagnostic criteria are defined empirically. Polymyalgia rheumatica was formerly considered to be a form of elderly onset rheumatoid arthritis. The progressive erosion process is absent in the case of polymyalgia rheumatica unlike in the case of rheumatoid arthritis. Numerous factors are known, which point to a link between polymyalgia rheumatica and giant cell vasculitis, arthritis, but the precise nature of this relationship remains unknown. Both conditions affect the same age group in the general population and they are even found--not infrequently--in the same patient. Polymyalgia rheumatica can be found in 40% of the patients suffering from arthritis while the histological examination detected mild vasculitis in approximately 10% of the patients suffering for "isolated" polymyalgia rheumatica. The response to be given to the acute phase is similar in both disorders. Scandinavian authors consider polymyalgia rheumatica as the appearance of generalised arthritis. Arthroscopic, nuclear magnetic resonance imaging as well as isotopic studies show unequivocally, that in the background of the osteo-muscular symptoms, complaints, inflammation is to be found partly of the joints but primarily that of the periarticular synovial structures. The above mentioned--dominant--proximal symptoms can often mask the distal locomotor disorders (pitting oedema of the hands and feet, tendonitis, tendosynovitis, carpal tunnel syndrome). The disorder may be accompanied by atypical generalised symptoms (loss of appetite, weight loss, fever, fatigue). An excellent indicators of the acute phase reactions are erythrocyte sedimentation rate, C-reactive protein and interleukin-6. These are suitable for monitoring the effectiveness of the therapy, for indicating a relapse/recurrence. It should be noted, that polymyalgia rheumatica may also be present if the erythrocyte sedimentation rate and C-reactive protein values are low. This disorder is also characterised by fast and effective response to corticosteroid, which should be administered for 1-2 years. In some individual cases a different dosage regime may be necessary: steroid administered in low dosage over a longer period of time. Administration of methotrexate and anti-tumor necrotic factor-alpha may also be considered as alternative or adjuvant therapy for lowering the quantity of corticosteroid. Further multicenter, double blind studies should, however, be performed on large number of patients in this regard.
Topics: Adrenal Cortex Hormones; Antirheumatic Agents; Edema; Fatigue; Fever; Humans; Incidence; Muscle Weakness; Polymyalgia Rheumatica; Tendinopathy; Weight Loss
PubMed: 17131799
DOI: No ID Found -
Australian Family Physician May 2011Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease and an indication for long term treatment with oral steroids. Its incidence rises progressively... (Review)
Review
BACKGROUND
Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease and an indication for long term treatment with oral steroids. Its incidence rises progressively beyond the age of 50 years. For the most part, PMR is managed in primary care.
OBJECTIVE
This article highlights the main points in the British Society for Rheumatology and the British Health Professionals in Rheumatology guidelines that may be useful to general practitioners in the primary care setting.
DISCUSSION
Different levels of awareness of the condition between practitioners, and a lack of uniform diagnostic criteria may impede correct diagnosis and management of PMR. Updated international guidelines produced by the British Society for Rheumatology and the British Health Professionals in Rheumatology can aid diagnosis and direct treatment and disease monitoring.
Topics: Adrenal Cortex Hormones; Bone Density Conservation Agents; Diagnosis, Differential; Giant Cell Arteritis; Humans; Polymyalgia Rheumatica; Practice Guidelines as Topic; Primary Health Care
PubMed: 21597550
DOI: No ID Found -
JAMA Jul 1978
Topics: Adrenal Cortex Hormones; Age Factors; Aged; Arthritis, Rheumatoid; Blood Sedimentation; Diagnosis, Differential; Humans; Middle Aged; Polymyalgia Rheumatica
PubMed: 660815
DOI: No ID Found