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Journal of Clinical Rheumatology :... Sep 2020
Topics: Diagnosis, Differential; Giant Cell Arteritis; Humans; Polymyalgia Rheumatica
PubMed: 32852929
DOI: 10.1097/RHU.0000000000001049 -
Journal of the American Association of... Dec 2022Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with... (Review)
Review
BACKGROUND
Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities.
OBJECTIVES
This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR.
DATA SOURCES
An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed.
CONCLUSIONS
Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted.
IMPLICATIONS FOR PRACTICE
Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.
Topics: Humans; Polymyalgia Rheumatica; Glucocorticoids; Systematic Reviews as Topic; Methotrexate; Treatment Outcome
PubMed: 35944226
DOI: 10.1097/JXX.0000000000000756 -
Expert Opinion on Pharmacotherapy Aug 2018Polymyalgia rheumatica (PMR), a common disease in individuals older than 50 in the western world, is characterized by bilateral inflammatory pain involving the shoulder... (Review)
Review
INTRODUCTION
Polymyalgia rheumatica (PMR), a common disease in individuals older than 50 in the western world, is characterized by bilateral inflammatory pain involving the shoulder girdle and less commonly the neck and pelvic girdle. The main goals of the currently available treatment are to induce remission and prevent relapse.
AREAS COVERED
This review briefly presents the main epidemiological and clinical features of PMR and discusses in depth both its classical management as well as new therapies used in PMR.
EXPERT OPINION
In general, patients with isolated PMR experience a rapid response (in less than seven days) to 12.5-25 mg/prednisone/day. Methotrexate is the conventional disease-modifying antirheumatic drug most commonly used for disease management, especially for relapses of the disease. However, this agent often yields a modest effect. Randomized controlled trials do not support the use of antitumor necrosis factor agents in PMR. Several case series and retrospective studies have highlighted the efficacy of the anti-interleukin-6 receptor antibody tocilizumab in PMR. However, controlled trials are needed to fully establish the efficacy of this biologic agent in PMR. The potential beneficial effect of the Janus-kinase inhibitors remains to be determined.
Topics: Humans; Polymyalgia Rheumatica; Retrospective Studies
PubMed: 30040482
DOI: 10.1080/14656566.2018.1501360 -
Lancet (London, England) Aug 1996
Topics: Blood Sedimentation; Humans; Polymyalgia Rheumatica
PubMed: 8757172
DOI: 10.1016/S0140-6736(05)64714-9 -
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 -
Der Internist Jan 2009Polymyalgia rheumatica (PMR) is a common chronic inflammatory rheumatic disease with unknown aetiology, affecting predominately people of middle age and older. Besides... (Review)
Review
Polymyalgia rheumatica (PMR) is a common chronic inflammatory rheumatic disease with unknown aetiology, affecting predominately people of middle age and older. Besides clinical symptoms and diagnostics, imaging techniques including sonography and magnetic resonance imaging may provide evidence of typical inflammatory lesions with bilateral bursitis subdeltoidea or subacromialis, tenosynovitis of the biceps tendon sheath and/or synovitis of the shoulder joints and thus may support the diagnosis of this disease in difficult cases. Corticosteroids are the cornerstone of treatment of PMR, but adverse events because of chronic corticosteroid use are observed in more than 50% of treated patients. Whether immunosuppressants, such as methotrexate and tumour necrosis factor-alpha inhibitors are effective in the therapy of PMR has still not yet been clarified.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Polymyalgia Rheumatica; Ultrasonography
PubMed: 19099273
DOI: 10.1007/s00108-008-2274-x -
Drugs Mar 1987Giant cell (temporal) arteritis was first described by Horton and colleagues in 1932, and polymyalgia rheumatica in 1957 by Barber who suggested this title for an entity... (Review)
Review
Giant cell (temporal) arteritis was first described by Horton and colleagues in 1932, and polymyalgia rheumatica in 1957 by Barber who suggested this title for an entity resembling, but distinct from, rheumatoid arthritis of unknown aetiology in the elderly. Arteritic features were sufficiently common in polymyalgia rheumatica to suggest an arteriopathy as a cause, further evidence of this being the change from the clinical picture picture of polymyalgia rheumatica to giant cell arteritis and vice versa in many patients such that the alternative title polymyalgia arteritica was suggested. The clinical picture of polymyalgia rheumatica is that of an elderly patient, more often female than male, usually over 60 years of age, with painful stiffness in the girdle joints and muscles of the shoulders and hips, but seldom with findings in peripheral or intermediate joints. The painful stiffness in the shoulders, hips and thighs is worse in the early morning. An erythrocyte sedimentation rate over 50mm in 1 hour is usual, and there is a rapid and dramatic response to small doses of corticosteroids (around 10mg prednisolone daily). Arteritic and axial arthritic features have been noted by different authors in different ratios, the disorder gradually abating naturally over periods varying from several months to 7 to 10 years. Deaths, when they occur in this elderly group of patients, have usually been unrelated to the disease or its treatment, but osteoporotic vertebral crush fractures are not uncommon. Partial or complete blindness may occur in patients with either giant cell arteritis or polymyalgia rheumatica, often appearing rapidly after cessation of corticosteroid therapy or rapid reduction of dosage.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adrenal Cortex Hormones; Diagnosis, Differential; Humans; Polymyalgia Rheumatica
PubMed: 3552598
DOI: 10.2165/00003495-198733030-00004 -
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 -
Joint Bone Spine Dec 2006Polymyalgia rheumatica (PMR) typically manifests as inflammatory pain in the shoulder and/or pelvic girdles in a patient over 50 years of age. This condition was long... (Review)
Review
Polymyalgia rheumatica (PMR) typically manifests as inflammatory pain in the shoulder and/or pelvic girdles in a patient over 50 years of age. This condition was long underrecognized and therefore underdiagnosed. Today, however, overdiagnosis may occur. Physicians must be aware that many conditions may simulate PMR, including diseases that carry a grim prognosis or require urgent treatment. PMR may be the first manifestation of giant cell arteritis, and a painstaking search for other signs is mandatory. PMR may inaugurate other rheumatologic diseases such as rheumatoid arthritis, RS3PE syndrome, spondyloarthropathy, systemic lupus erythematosus (SLE), myopathy, vasculitis, and chondrocalcinosis. Finally, PMR may be the first manifestation of an endocrine disorder, a malignancy, or an infection. Failure to respond to glucocorticoid therapy should suggest giant cell arteritis, malignant disease, or infection. Ultrasonography may assist in the diagnosis by showing bilateral subdeltoid bursitis. Glucocorticoids are the mainstay of the treatment of PMR. Although the optimal starting dosage and tapering schedule are not agreed on, a low starting dosage and slow tapering may decrease the relapse rate. Methotrexate is probably useful when glucocorticoid dependency develops. In contrast, TNF-alpha antagonists are probably ineffective.
Topics: Diagnosis, Differential; Humans; Polymyalgia Rheumatica
PubMed: 17113808
DOI: 10.1016/j.jbspin.2006.09.005 -
Expert Review of Clinical Immunology Mar 2021Polymyalgia rheumatica (PMR) is a common inflammatory disease found in people older than 50 years of Northern European descent. It is characterized by pain and... (Review)
Review
INTRODUCTION
Polymyalgia rheumatica (PMR) is a common inflammatory disease found in people older than 50 years of Northern European descent. It is characterized by pain and stiffness in the shoulders, arms, hips, and neck. Relapses are common in patients with PMR.
AREAS COVERED
This review describes when and how relapses occur in patients with PMR. Potential predisposing factors associated with relapses and management are also discussed. An extensive literature search on the PubMed database was conducted for publications on 'polymyalgia rheumatica' AND 'relapses' AND 'risk factors'.
EXPERT OPINION
Relapses are common in PMR being observed in approximately half of the patients. They often occur when the dose of prednisone is below 5-7.5 mg/day. The speed of glucocorticoid tapering is considered to be the main factor influencing the development of relapses in isolated PMRs. In addition, a genetic component may favor the presence of relapses in isolated PMRs. HLA-DRB1*0401 alleles were associated with an increased risk of relapse. An implication of the IL-6 promoter -174 G/C polymorphism and the GG241 ICAM-1 genotype was also reported. With regard to serological biomarkers, elevated levels of angiopoietin-2 were associated with an unfavorable course of PMR. Methotrexate and anti-IL6 receptor antibody tocilizumab may be required in PMR patients with multiple relapses.
Topics: Humans; Polymyalgia Rheumatica; Prednisone; Recurrence; Risk Factors
PubMed: 33570454
DOI: 10.1080/1744666X.2021.1890032