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BioMed Research International 2014Giant cell arteritis (GCA) is the most common vasculitis affecting medium and large vessels. It shows a close clinical association with polymyalgia rheumatica (PMR), a... (Review)
Review
Giant cell arteritis (GCA) is the most common vasculitis affecting medium and large vessels. It shows a close clinical association with polymyalgia rheumatica (PMR), a musculoskeletal inflammatory disorder, which is clinically characterized by girdles pain and stiffness. 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is an effective tool for the diagnosis, grading, and follow-up of patients affected by GCA involving the aorta and its proximal branches, but the lack of a standardized method for the assessment of vascular inflammation remains a critical issue, potentially leading to misclassification. In our systematic review, including 19 original articles for a total of 442 GCA patients (with or without PMR symptoms) and 535 healthy controls, we described the different qualitative, semiquantitative and combined methods that have been proposed throughout the literature for assessing the presence and grading the severity of GCA-related vascular inflammation on 18F-FDG PET scans, focusing on the diagnostic performance and examining their respective advantages and limitations. The majority of the included studies adopted qualitative methods of PET image analysis, which are less sensitive but more specific than semiquantitative ones. Among the semiquantitative approaches, the aortic-to-blood pool uptake ratio of the aortic arch seems to be the most accurate method.
Topics: Aorta, Thoracic; Fluorodeoxyglucose F18; Giant Cell Arteritis; Humans; Inflammation; Polymyalgia Rheumatica; Positron-Emission Tomography; Radiography; Vasculitis
PubMed: 25254211
DOI: 10.1155/2014/574248 -
The Journal of Rheumatology Apr 2014We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified... (Review)
Review
We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.
Topics: Consensus Development Conferences as Topic; Female; Focus Groups; Humans; Longitudinal Studies; Male; Pain Measurement; Patient Satisfaction; Polymyalgia Rheumatica; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Steroids
PubMed: 24488422
DOI: 10.3899/jrheum.131254 -
Clinical and Experimental Rheumatology 2013Musculoskeletal ultrasonography (US) has lately been applied to patients with polymyalgia rheumatica for the examination of shoulders and hip, and included in the 2012... (Review)
Review
Ultrasound imaging for the rheumatologist XLIII. Ultrasonographic evaluation of shoulders and hips in patients with polymyalgia rheumatica: a systematic literature review.
OBJECTIVES
Musculoskeletal ultrasonography (US) has lately been applied to patients with polymyalgia rheumatica for the examination of shoulders and hip, and included in the 2012 PMR classification criteria. We aimed to perform a comprehensive overview of the literature on this topic with a systematic review.
METHODS
We searched PubMed, Embase, the Cochrane library and the proceedings from EULAR and ACR congresses (2011-2012). We included studies evaluating patients with confirmed or suspected PMR, undergoing US of shoulders and/or hips. The diagnosis of PMR could be based on expert opinion or diagnostic criteria. Cohort, case-control, diagnostic accuracy studies and case-series were eligible for inclusion. The features of the included studies were presented. When available, sensitivities and specificities were calculated for primary studies.
RESULTS
Out of 1736 papers identified by our search, 13 articles and 1 abstract were finally included in the review. Eight studies focused on shoulder US, 1 on hip US, 4 on both. Studies were extremely variable in terms of population, US examination, reference standard and control population. In general, at the shoulder, pathological bilateral US findings in most studies were more prevalent in patients with PMR compared to controls. When sensitivity and specificity could be calculated, bilateral findings were more sensitive. Notably, less information was available on hip US.
CONCLUSIONS
US (especially in shoulder examination) is confirmed to be a potentially useful instrument to integrate clinical information in the management of patients with PMR. Its additional value in conjunction with the new classification criteria should be further tested.
Topics: Hip Joint; Humans; Muscle, Skeletal; Polymyalgia Rheumatica; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Shoulder Joint; Tendons; Ultrasonography
PubMed: 23369808
DOI: No ID Found -
Arthritis Care & Research Sep 2012To systematically identify and appraise the existing literature on the association between polymyalgia rheumatica (PMR) and vascular disease. (Review)
Review
OBJECTIVE
To systematically identify and appraise the existing literature on the association between polymyalgia rheumatica (PMR) and vascular disease.
METHODS
The Medline, Embase, CINAHL, and Cochrane databases were searched from inception to September 2010. Search criteria included observational studies containing patients with isolated PMR reporting on a vascular outcome. Data were extracted and articles were assessed for quality.
RESULTS
The database search identified 545 articles. Eight articles reporting on 7 unique studies were included in the final review. Four studies reported on vascular mortality and 3 studies reported on other vascular outcomes. Four of the studies reported statistically significant positive associations between PMR and vascular disease and 3 studies reported no statistically significant results. The heterogeneity of the results was investigated; the strongest explanatory variable was that 2 of 3 studies that reported nonsignificant results were prospective, whereas all of those studies reporting significant results were retrospective.
CONCLUSION
There is some evidence to suggest that, like other inflammatory rheumatic disorders, PMR may be linked to an increased risk of vascular disease. Further studies are required to quantify the level of risk to determine whether patients with PMR should be actively screened for cardiovascular disease and its risk factors.
Topics: Female; Humans; Male; Middle Aged; Odds Ratio; Polymyalgia Rheumatica; Prognosis; Risk Assessment; Risk Factors; Vascular Diseases
PubMed: 22514197
DOI: 10.1002/acr.21712 -
The Cochrane Database of Systematic... 2003While many treatments, including corticosteroid injections in and around the shoulder, are advocated to be of benefit for shoulder pain, few are of proven efficacy. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
While many treatments, including corticosteroid injections in and around the shoulder, are advocated to be of benefit for shoulder pain, few are of proven efficacy. This review of corticosteroid injections for shoulder pain is one in a series of reviews of varying interventions for shoulder disorders.
OBJECTIVES
To determine the efficacy and safety of corticosteroid injections in the treatment of adults with shoulder pain.
SEARCH STRATEGY
MEDLINE, EMBASE, CINAHL, Central and Science Citation Index were searched up to and including June 2002.
SELECTION CRITERIA
Randomised and pseudo-randomised trials in all languages of corticosteroid injections compared to placebo or another intervention, or of varying types and dosages of steroid injection in adults with shoulder pain. Specific exclusions were duration of shoulder pain less than three weeks, rheumatoid arthritis, polymyalgia rheumatica and fracture.
DATA COLLECTION AND ANALYSIS
Trial inclusion and methodological quality was assessed by two independent reviewers according to predetermined criteria. Results are presented separately for rotator cuff disease, adhesive capsulitis, full thickness rotator cuff tear and mixed diagnoses, and, where possible, combined in meta-analysis.
MAIN RESULTS
Twenty-six trials met inclusion criteria. The number, site and dosage of injections varied widely between studies. The number of participants per trial ranged from 20 to 114 (median 52 participants). Methodological quality was variable. For rotator cuff disease, subacromial steroid injection was demonstrated to have a small benefit over placebo in some trials however no benefit of subacromial steroid injection over NSAID was demonstrated based upon the pooled results of three trials. For adhesive capsulitis, two trials suggested a possible early benefit of intra-articular steroid injection over placebo but there was insufficient data for pooling of any of the trials. One trial suggested short-term benefit of intra-articular corticosteroid injection over physiotherapy in the short-term (success at seven weeks RR=1.66 (1.21, 2.28).
REVIEWER'S CONCLUSIONS
Despite many RCTs of corticosteroid injections for shoulder pain, their small sample sizes, variable methodological quality and heterogeneity means that there is little overall evidence to guide treatment. Subacromial corticosteroid injection for rotator cuff disease and intra-articular injection for adhesive capsulitis may be beneficial although their effect may be small and not well-maintained. There is a need for further trials investigating the efficacy of corticosteroid injections for shoulder pain. Other important issues that remain to be clarified include whether the accuracy of needle placement, anatomical site, frequency, dose and type of corticosteroid influences efficacy.
Topics: Adrenal Cortex Hormones; Adult; Anti-Inflammatory Agents, Non-Steroidal; Bursitis; Humans; Injections, Intra-Articular; Randomized Controlled Trials as Topic; Rotator Cuff Injuries; Shoulder Pain
PubMed: 12535501
DOI: 10.1002/14651858.CD004016