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Manzo C, Isetta M, Castagna A. Did the first description of patients with polymyalgia rheumatica take place in Scotland or in Denmark? Reumatismo 2024; 76. [PMID: 38523578 DOI: 10.4081/reumatismo.2024.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/22/2023] [Indexed: 03/26/2024] Open
Abstract
The first description of polymyalgia rheumatica (PMR) is generally attributed to Dr. Bruce. In an 1888 article entitled Senile rheumatic gout, he described five male patients aged from 60 to 74 years whom he had visited at the Strathpeffer spa in Scotland. In 1945, Dr. Holst and Dr. Johansen reported on five female patients examined over several months at the Medical Department of Roskilde County Hospital in Denmark. These patients suffered from hip, upper arms, and neck pain associated with elevated ESR and constitutional manifestations such as low-grade fever or loss of weight. In the same year, Meulengracht, another Danish physician, reported on two patients with shoulder pain and stiffness associated with fever, weight loss, and an increased erythrocyte sedimentation rate. As in the five patients reported by Dr. Holst and Dr. Johansen, a prolonged recovery time was recorded. On reading and comparing these three accounts, we question whether it is correct to attribute the first description of PMR to Dr. Bruce and put forward shifting this accolade to the three Danish physicians.
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Affiliation(s)
- C Manzo
- Internal and Geriatric Medicine Department, Rheumatology Outpatient Clinic, Health Authority Napoli 3 sud, Sant'Agnello.
| | - M Isetta
- Central and North West London NHS Trust, London.
| | - A Castagna
- Primary Care Department, Catanzaro Provincial Health Authority, Soverato.
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Bond M, Dejaco C. Polymyalgia rheumatica: crafting the future of a simple (but not easy!) clinical syndrome. Ann Rheum Dis 2024; 83:271-273. [PMID: 38071513 DOI: 10.1136/ard-2023-225192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Milena Bond
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
- Department of Rheumatology, Medical University of Graz, Graz, Austria
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Nogi S, Oka S, Higuchi T, Furukawa H, Shimada K, Azuma T, Sugiyama T, Hirano F, Okamoto A, Fujimori M, Horai Y, Ihata A, Hashimoto A, Komiya A, Matsui T, Fukui N, Katayama M, Migita K, Tohma S. Human leucocyte antigens and Japanese patients with polymyalgia rheumatica: the protective effect of DRB1*09:01. RMD Open 2024; 10:e003897. [PMID: 38253597 PMCID: PMC10806501 DOI: 10.1136/rmdopen-2023-003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE The hallmarks of the chronic inflammatory disease polymyalgia rheumatica (PMR) include pain, and morning stiffness in areas of the neck, shoulder and pelvic girdle. The human leucocyte antigen (HLA) gene was reported to be an important risk factor for PMR, but it has not been analysed precisely, especially in populations other than Europeans. METHODS Genotyping of DRB1 and DQB1 was performed in Japanese PMR patients (n=270) and controls (n=413). Associations between allele carrier and genotype frequencies were determined for PMR. RESULTS DRB1*04:05 was associated with a predisposition to PMR (p=0.0006, Pc=0.0193, OR 1.85, 95% CI 1.31 to 2.62). DRB1*09:01 was associated with protection against PMR (p=1.46×10-5, Pc=0.0004, OR 0.40, 95% CI 0.26 to 0.61). A shared epitope (SE) associated with PMR (p=3.07×10-6, OR 2.11, 95% CI 1.54 to 2.88). DQB1*03:03 (p=0.0010, Pc=0.0140, OR 0.52, 95% CI 0.35 to 0.77) was associated with protection against PMR and DQB1*04:01 (p=0.0009, Pc=0.0140, OR 1.82, 95% CI 1.28 to 2.58) was associated with predisposition to PMR. A gene dosage effect was observed for DRB1*09:01 and DQB1*03:03, but not for DRB1*04:05, SE or DQB1*04:01. Haplotype and logistic regression analyses suggested a protective effect for DRB1*09:01. CONCLUSION This study is the first to demonstrate predisposing associations of DRB1*04:05, SE, and DQB1*04:01, and protective associations of DRB1*09:01 and DQB1*03:03 with PMR in Japanese patients. Our data indicate HLA has predisposing and protective effects on the pathogenesis of PMR.
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Affiliation(s)
- Shinichi Nogi
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Shomi Oka
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Takashi Higuchi
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
| | - Hiroshi Furukawa
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Kota Shimada
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Japan
| | | | - Takao Sugiyama
- Department of Rheumatology, NHO Shimoshizu Hospital, Yotsukaido, Japan
| | - Fuminori Hirano
- Department of Internal Medicine, NHO Asahikawa Medical Center, Asahikawa, Japan
| | - Akira Okamoto
- Department of Rheumatology, NHO Himeji Medical Center, Himeji, Japan
| | - Misuzu Fujimori
- Department of Rheumatology, NHO Himeji Medical Center, Himeji, Japan
| | - Yoshiro Horai
- Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan
- Department of Rheumatology, Sasebo City General Hospital, Sasebo, Japan
| | - Atsushi Ihata
- Department of Rheumatology, NHO Yokohama Medical Center, Yokohama, Japan
| | - Atsushi Hashimoto
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Akiko Komiya
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Clinical Laboratory, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Toshihiro Matsui
- Department of Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Naoshi Fukui
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
- Department of Life Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
| | - Masao Katayama
- Department of Internal Medicine, NHO Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kiyoshi Migita
- Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shigeto Tohma
- Department of Clinical Research, NHO Tokyo National Hospital, Kiyose, Japan
- Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
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Antiochos B. Tocilizumab as a Novel Therapy for Steroid-Dependent Polymyalgia Rheumatica. JAMA 2022; 328:1047-1048. [PMID: 36125486 DOI: 10.1001/jama.2022.11526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Osada A, Sakuragi C, Toya C, Mitsuo A. New-onset Polymyalgia Rheumatica Following the Administration of the Pfizer-BioNTech COVID-19 Vaccine. Intern Med 2022; 61:749-753. [PMID: 34897152 PMCID: PMC8943385 DOI: 10.2169/internalmedicine.8651-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We herein report the case of an 80-year-old Japanese woman who presented to our hospital with bilateral pain in the shoulders and hips lasting for a month since 2 days after the second dose of the BNT162b2 COVID-19 vaccine. Her physical findings, laboratory data, and ultrasonographic findings of bilateral biceps tenosynovitis and lateral subacromial bursitis were consistent with a diagnosis of polymyalgia rheumatica (PMR). She was successfully treated with oral prednisolone 15 mg/day. Although a causal relationship could not be definitively confirmed, PMR should be considered as a differential diagnosis in cases of persistent myalgia after administration of the BNT162b2 vaccine.
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Affiliation(s)
- Atsumu Osada
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
| | - Chinatsu Sakuragi
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
| | - Chisashi Toya
- Division of Cardiology, National Hospital Organization Disaster Medical Center, Japan
| | - Akiko Mitsuo
- Division of Rheumatology, National Hospital Organization Disaster Medical Center, Japan
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Solimando AG, Vacca A, Dammacco F. Highlights in clinical medicine-Giant cell arteritis, polymyalgia rheumatica and Takayasu's arteritis: pathogenic links and therapeutic implications. Clin Exp Med 2021; 22:509-518. [PMID: 34741677 DOI: 10.1007/s10238-021-00770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
Giant cell arteritis (GCA), frequently associated with polymyalgia rheumatica (PMR), and Takayasu's arteritis (TAK) are characterized by extensive vascular remodeling that results in occlusion and stenosis. The pathophysiological mechanisms underlying the onset of GCA/PMR and TAK are still hypothetical. However, similarities and differences in the immunopathology and clinical phenotypes of these diseases point toward a possible link between them. The loss of tolerance in the periphery, a breakdown of tissue barriers, and the development of granulomatous vasculitis define a disease continuum. However, statistically powered studies are needed to confirm these correlations. In addition to glucocorticoids, inhibition of the interleukin-6 axis has been proposed as a cornerstone in the treatment of GCA/PMR and TAK. Novel biologic agents targeting the pathogenic pathway at various levels hold promise to achieve glucocorticoid-free sustained remission.
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Affiliation(s)
- Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Medical School, Polyclinic, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
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Carvajal Alegria G, Boukhlal S, Cornec D, Devauchelle-Pensec V. The pathophysiology of polymyalgia rheumatica, small pieces of a big puzzle. Autoimmun Rev 2020; 19:102670. [DOI: 10.1016/j.autrev.2020.102670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
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Abstract
PURPOSE OF THE REVIEW Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50 years of age along with evidence of an intense systemic inflammatory response. Although the above clinical symptoms are very characteristic for the condition, it can be mimicked by other autoimmune, infectious, malignant, and endocrine disorders chief among which are giant cell arteritis (GCA) and elderly-onset rheumatoid arthritis (EORA). Recently, PMR was reported in relation to treatment with immune checkpoint inhibitors. Current treatment of PMR consists of low-to-medium doses of glucocorticosteroids (GC) with variable response rates and disease recurrence estimated to occur in 50% of patients while tapering down GC doses. In addition, GC-based regimens cause much of the morbidity associated with PMR in older adults, requiring close monitoring for GC-induced toxicity during therapy and highlighting the need for novel therapeutic strategies. Here, we review the latest findings in the field regarding specific etiologic factors, genetic associations, diagnostic methods, and advancements in treatment strategies and disease monitoring indices. RECENT FINDINGS Recent discoveries involving novel therapeutic targets in GCA have accelerated the study of PMR pathophysiology and have advanced treatment strategies in PMR management leading to current trials in IL-6 blocking agents. PMR remains an enigmatic inflammatory condition affecting older adults, with current treatment approach causing much morbidity in this patient population. Advancements in our understanding of novel immunopathologic targets can serve as a solid foundation for future treatment strategies in the field.
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Leung JL, Owen CE, Buchanan RRC, Liew DFL. Management of polymyalgia rheumatica in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jessica L. Leung
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Claire E. Owen
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - Russell R. C. Buchanan
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
| | - David F. L. Liew
- Department of Rheumatology Austin Health Melbourne Australia
- The University of Melbourne Melbourne Australia
- Department of Clinical Pharmacology and Therapeutics Austin Health Melbourne Australia
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Tani K, Kawaminami S, Okura Y, Tabata R, Yuasa S, Nakanishi Y, Kawahito K, Inaba K, Inaba K, Kondo K, Umetani K, Miyatake A, Suzuki Y, Yamaguchi H. Predictive factors associated with the therapeutic response in patients with polymyalgia rheumatica and remitting seronegative symmetrical synovitis with pitting edema syndrome. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:112-118. [DOI: 10.2152/jmi.66.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenji Tani
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Shingo Kawaminami
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Yoshihiro Okura
- General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Ryo Tabata
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Shino Yuasa
- Tokushima Prefectural Central Hospital, Tokushima,Japan
| | - Yoshinori Nakanishi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | - Keisuke Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Kaori Inaba
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | | | | | | | - Yoshihiro Suzuki
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
| | - Harutaka Yamaguchi
- Department of General Medicine, Institute ofBiomedical Sciences, the University of Tokushima Graduate School, Tokushima, Japan
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Do JG, Park J, Sung DH. Characteristics of Korean Patients with Polymyalgia Rheumatica: a Single Locomotive Pain Clinic Cohort Study. J Korean Med Sci 2018; 33:e241. [PMID: 30181732 PMCID: PMC6115692 DOI: 10.3346/jkms.2018.33.e241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/14/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Polymyalgia rheumatica (PMR) is a common systemic inflammatory disease of the elderly; however, the clinical characteristics and therapeutic response of PMR in Korea have been rarely studied. METHODS We reviewed the medical records of 54 Korean patients diagnosed with PMR between January 2009 and February 2017 in a locomotive pain clinic of one tertiary referral hospital. We analyzed epidemiologic and clinical characteristics, therapeutic responses, and prognostic factors for remission-failure at one-year after oral prednisolone treatment. RESULTS In 54 patients with PMR, 32 (59.3%) were female. The average age at diagnosis was 65.0 ± 10.5 years. Duration of symptoms before diagnosis was 8.1 ± 8.6 months. All patients had shoulder pain (54 patients, 100.0%); 49 patients (90.7%) had hip girdle pain, while 19 patients (35.2%) had peripheral joint pain. Four patients (7.4%) were accompanied by the giant cell arteritis (GCA). There was no seasonal preference for symptom development. Only 19 patients were diagnosed with PMR at initial symptom presentation. At one-year follow-up after oral prednisolone treatment, the remission rate was 35.3% (12/34). Multivariate analysis showed that history of relapse (odds ratio, 6.81; 95% confidence interval, 1.035-44.804) was a significant predictor of remission-failure. CONCLUSION The rate of remission (35.3%) after oral prednisolone treatment was similar to previous reports in western countries; and GCA is not a rare condition in Korean PMR patients. Misdiagnosis of PMR is common, and heightened consideration for PMR is needed in elderly patients who present inflammatory features of bilateral shoulder pain.
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Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Park
- Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Milchert M, Brzosko M. Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient. Indian J Med Res 2017; 145:593-600. [PMID: 28948949 PMCID: PMC5644293 DOI: 10.4103/ijmr.ijmr_298_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is a unique disease of elderly people, traditionally diagnosed based on a clinical picture. A typical case is a combination of severe musculoskeletal symptoms and systemic inflammatory response with spectacular response to corticosteroids treatment. The severity of symptoms may be surprising in older patients where immunosenescence is normally expected. However, PMR may be diagnosed in haste if there is a temptation to use this diagnosis as a shortcut to achieve rapid therapeutic success. Overdiagnosis of PMR may cause more problems compared to underdiagnosis. The 2012 PMR criteria proposed by European League against Rheumatism/American College of Rheumatology aim to minimize the role of clinical intuition and build on more objective features. However, questions arise if this is possible in PMR. This has been discussed in this review.
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Affiliation(s)
- Marcin Milchert
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
| | - Marek Brzosko
- Department of Rheumatology, Internal Medicine & Geriatrics, Pomeranian Medical University, Szczecin, Poland
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Radenska-Lopovok SG, Kotenko ON, Frolova NF, Zagrebneva AI, Stolyarevich ES, Volodina EV, Chervinko VI, Kryukov EV, Zubkin ML. [A rare concurrence of polymyalgia rheumatica and AA-amyloidosis]. Arkh Patol 2017; 79:53-57. [PMID: 28418359 DOI: 10.17116/patol201779253-57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Polymyalgia rheumatica (PMR) is a rare chronic inflammatory disease. It predominantly affects the elderly. The disease has a slow onset, pain and stiffness in the muscles of the shoulder and pelvic girdle, fever, weight loss, and a high acute-phase inflammatory response. The disease is concurrent with giant cell arteritis in a quarter of cases, which allows some authors to consider them as two different manifestations of the same pathological process. The kidneys are rarely involved. This disease is rarely complicated by AA amyloidosis. The authors describe a case of RPM in a patient who has developed secondary AA amyloidosis.
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Affiliation(s)
- S G Radenska-Lopovok
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Russian Medical Academy of Postgraduate Education, Ministry of Health of the Russian Federation, Moscow, Russia
| | - O N Kotenko
- Moscow City Clinical Hospital Fifty-Two, Moscow Healthcare Department, Moscow, Russia
| | - N F Frolova
- Moscow City Clinical Hospital Fifty-Two, Moscow Healthcare Department, Moscow, Russia
| | - A I Zagrebneva
- Moscow City Clinical Hospital Fifty-Two, Moscow Healthcare Department, Moscow, Russia
| | - E S Stolyarevich
- Moscow City Clinical Hospital Fifty-Two, Moscow Healthcare Department, Moscow, Russia
| | - E V Volodina
- G.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia
| | - V I Chervinko
- Branch, S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - E V Kryukov
- N.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of the Russian Federation, Moscow, Russia
| | - M L Zubkin
- Moscow City Clinical Hospital Fifty-Two, Moscow Healthcare Department, Moscow, Russia; G.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology, Russian Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Moscow, Russia; Branch, S.M. Kirov Military Medical Academy, Ministry of Defense of the Russian Federation, Moscow, Russia
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Yates M, Graham K, Watts RA, MacGregor AJ. The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. BMC Musculoskelet Disord 2016; 17:285. [PMID: 27421253 PMCID: PMC4946178 DOI: 10.1186/s12891-016-1127-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 06/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background To update community-based prevalence values for Polymyalgia Rheumatic (PMR) and Giant Cell Arteritis (GCA) using case record review supplemented by population survey and subsequent clinical review. Methods Clinical data were obtained from case records of a large primary care practice in Norfolk, UK and reviewed for diagnoses of GCA and PMR. In addition postal survey was carried out to capture potentially undiagnosed cases within the practice population. Those screening positive for potential diagnoses of GCA and PMR were invited for clinical review. A cumulative prevalence estimate was subsequently calculated on those diagnosed within the GP practice and subsequently on those fulfilling the various published classification criteria sets. The date of the database lock and mail merge was March 2013. Results Through detailed systematic review of 5,159 GP case records, 21 patients had a recorded diagnosis of GCA and 117 had PMR.No new cases were identified among 2,227 completed questionnaires returned from the population survey of a sample of 4,728. The resulting cumulative prevalence estimate in those aged ≥ 55 years meeting the ACR classification criteria set for GCA was 0.25 % (95 % CI 0.11 to 0.39 %) and for five published criteria sets for PMR ranged from 0.91 to 1.53 % (95 % CI ranges 0.65 %, 1.87 %). The prevalence of both conditions was higher in women than in men and in older age groups. Conclusion This study provides the first UK prevalence estimate of GCA and PMR in over 30 years and is the first to apply classification criteria sets.
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Affiliation(s)
- Max Yates
- Department of Rheumatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK. .,Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk, NR4 7UQ, UK.
| | - Karly Graham
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk, NR4 7UQ, UK
| | - Richard Arthur Watts
- Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk, NR4 7UQ, UK
| | - Alexander James MacGregor
- Department of Rheumatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.,Norwich Medical School, Bob Champion Research and Education Building, University of East Anglia, Norwich, Norfolk, NR4 7UQ, UK
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Fukui S, Nunokawa T, Kobayashi S, Kamei S, Yokogawa N, Takizawa Y, Shimada K, Sugii S, Setoguchi K. MMP-3 can distinguish isolated PMR from PMR with GCA: A retrospective study regarding PMR and GCA in Japan. Mod Rheumatol 2015; 26:259-64. [PMID: 26156043 DOI: 10.3109/14397595.2015.1071304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We sought to identify clinical features at diagnosis that can distinguish isolated polymyalgia rheumatica (PMR) without giant cell arteritis (GCA) from PMR with GCA, and clinical features at diagnosis of isolated PMR that can predict subsequent relapse and corticosteroid discontinuation. METHODS A retrospective study of 115 patients with isolated PMR and 29 patients with GCA was performed. A comparison between isolated PMR patients, GCA patients (with or without PMR), and PMR with GCA patients was performed. Predictors of relapse and corticosteroid discontinuation were identified using a logistic regression in the patients with isolated PMR. RESULTS Matrix metalloproteinase-3 (MMP-3) level was significantly different among the patient groups. MMP-3: 230.5 ± 201.5 ng/mL in isolated PMR, 80.5 ± 47.5 ng/mL in GCA (p < 0.01), and 96.8 ± 54.8 ng/mL in PMR with GCA (p = 0.03). In the patients with isolated PMR, female gender (odds ratio [OR], 2.73; 95% confidence interval [CI], 1.16-6.41; p < 0.05) and creatinine (Cr) < 50 μmol/L (OR, 2.48; 95% CI, 1.02-5.99; p < 0.05) were significant prognostic factors that predicted relapse. CONCLUSION A low level of MMP-3 is an excellent positive predictor for PMR with GCA. Among patients with isolated PMR, female gender and Cr < 50 μmol/L were significant prognostic factors that predicted relapse.
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Affiliation(s)
- Shoichi Fukui
- a Department of Rheumatology , Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital , Tokyo , Japan.,c Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Takahiro Nunokawa
- b Department of Rheumatology , Tokyo Metropolitan Tama Medical Center , Tokyo , Japan
| | - Satomi Kobayashi
- a Department of Rheumatology , Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital , Tokyo , Japan
| | - Satoshi Kamei
- a Department of Rheumatology , Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital , Tokyo , Japan
| | - Naoto Yokogawa
- b Department of Rheumatology , Tokyo Metropolitan Tama Medical Center , Tokyo , Japan
| | - Yasunobu Takizawa
- a Department of Rheumatology , Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital , Tokyo , Japan
| | - Kota Shimada
- b Department of Rheumatology , Tokyo Metropolitan Tama Medical Center , Tokyo , Japan
| | - Shoji Sugii
- b Department of Rheumatology , Tokyo Metropolitan Tama Medical Center , Tokyo , Japan
| | - Keigo Setoguchi
- a Department of Rheumatology , Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital , Tokyo , Japan
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Pneumatosis cystoides intestinalis related to α-glucosidase inhibitor treatment in a polymyalgia rheumatica patient with diabetes mellitus. Diabetol Int 2014. [DOI: 10.1007/s13340-014-0158-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVES On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the clinical care of affected patients. METHODS The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia rheumatica and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. Apart from the elevation of circulating acute phase proteins, which has been recognised as a feature of polymyalgia rheumatica for over 60 years, the diagnosis receives no significant help from the laboratory or from diagnostic imaging. RESULTS This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts including those using the advances in clinical imaging technology over the past 60 years, have done little to change the ability of clinicians to define the disease more accurately. Since the introduction of corticosteroids in the 1950s, there has been also very little change in the clinical management of the condition. CONCLUSIONS Polymyalgia rheumatica remains a clinical enigma, and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely, and until then, preventing the pain and stiffness of the disease while avoiding the problems of prolonged exoposure to corticosteroids is likely to remain elusive or serendipitous.
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Affiliation(s)
- Patrick J Rooney
- Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Jennifer Rooney
- Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Geza Balint
- Consultant Rheumatologist, National Institute of Rheumatology and Physiotherapy, Hungary
| | - Peter Balint
- Head of Department and Consultant Rheumatologist, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Hungary
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Giant cell arteritis: a systematic review of the qualitative and semiquantitative methods to assess vasculitis with 18F-fluorodeoxyglucose positron emission tomography. BIOMED RESEARCH INTERNATIONAL 2014; 2014:574248. [PMID: 25254211 PMCID: PMC4165737 DOI: 10.1155/2014/574248] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
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.
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Matteson EL. 1. Polymyalgia rheumatica and giant cell arteritis: past, present and future. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
DEFINITION AND EPIDEMIOLOGY Polymyalgia rheumatica (PMR) is a very painful inflammatory disease which regularly affects the shoulder region but in 70% of cases the pelvic girdle region is also affected. The disease occurs in people over the age of 50 years and reaches a peak at 72 years old. Women are affected twice as often as men. The prevalence is estimated to be 0.3-0.7% in the Caucasian population over 50 years old. DIAGNOSTICS AND CLASSIFICATION Misdiagnosis of PMR is common. The differential diagnosis primarily includes impingement syndrome, osteoarthritis of the shoulders, calcifying tendinitis of the rotator cuff, bursitis, omarthritis or inflammatory rheumatic diseases, such as rheumatoid arthritis. Taking a structured medical history and performing a thorough clinical examination are crucial. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are usually highly elevated and should be investigated particularly in patients who present with new onset bilateral shoulder pain and pronounced general impairment of movement. Imaging shows characteristic inflammatory changes around the shoulders and hip joints. The new European League Against Rheumatism and American College of Rheumatology (EULAR/ACR) classification criteria of PMR including ultrasound imaging are superior to previous classification and diagnostic criteria in terms of positive and negative predictive values. THERAPY Glucocorticoids are still the mainstay of treatment. Recommended daily prednisolone starting doses are between 15 mg and 25 mg with a weekly dose reduction until 10 mg/day and then further dose reductions of 1 mg per month. Methotrexate can aid reducing prednisolone doses in patients who fail to reach doses below the Cushing threshold quickly enough, which can have major side effects.
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Chhabra L, Devadoss R, Gnanapandithan K, Spodick DH. Pleuropericardial effusion: an unusual presentation of polymyalgia rheumatica. CASE REPORTS 2014; 2014:bcr-2014-203881. [DOI: 10.1136/bcr-2014-203881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
Vision changes and ophthalmic complaints may represent potentially serious, sometimes fatal, systemic illnesses. This article summarizes the presenting signs and symptoms of retinal artery occlusion, giant cell arteritis, and oculomotor nerve palsy.
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Pipitone N, Salvarani C. Update on polymyalgia rheumatica. Eur J Intern Med 2013; 24:583-9. [PMID: 23579169 DOI: 10.1016/j.ejim.2013.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/02/2013] [Accepted: 03/06/2013] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Nicolò Pipitone
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
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Soriano A, Landolfi R, Manna R. Polymyalgia rheumatica in 2011. Best Pract Res Clin Rheumatol 2013; 26:91-104. [PMID: 22424196 DOI: 10.1016/j.berh.2012.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 01/03/2012] [Accepted: 01/04/2012] [Indexed: 01/30/2023]
Abstract
Polymyalgia Rheumatica (PMR) is an inflammatory rheumatic disease that commonly affects individuals over 50 years of age, characterised by pain and morning stiffness of the shoulder and pelvic girdle. PMR can present as 'isolated' form or may be associated with giant cell arteritis. The progress of imaging techniques has helped in understanding different clinical patterns: subclinical vasculitis can occur in at least one-third of PMR patients, causing ischaemic complications. It is considered a polygenic disease and environmental factors may play a role in its pathogenesis, such as viral or bacterial triggers, both in the 'wide' form or assembled with adjuvants in vaccines. The response to steroid therapy is generally dramatic and side effects may occur, as well as the development of glucocorticoid resistance. The optimisation of therapy may require steroid-sparing agents as well as modified-release prednisone as 'nighttime' replacement therapy.
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Affiliation(s)
- Alessandra Soriano
- Clinical Autoimmunity Unit - Periodic Fever Research Centre, Catholic University of the Sacred Heart, L.go F. Vito N1, 00168 Rome, Italy
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Takeshima E, Morishita Y, Ogura M, Ito C, Saito O, Takemoto F, Ando Y, Muto S, Yumura W, Kusano E. A case of diffuse endocapillary proliferative glomerulonephritis associated with polymyalgia rheumatica. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2012; 2:158-64. [PMID: 23326256 PMCID: PMC3542932 DOI: 10.1159/000345280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 70-year-old man complained of muscle pain in his neck, shoulders and pelvic girdle. Proteinuria and hematuria subsequently developed. Blood analysis showed increased acute phase reactants. The histology of renal biopsy showed diffuse endocapillary proliferative glomerulonephritis. There were no signs of autoimmune diseases, malignancies and bacterial or viral infections. His extrarenal symptoms and the results of blood analysis fulfilled three different criteria of polymyalgia rheumatica (PMR). Therefore, diffuse endocapillary proliferative glomerulonephritis associated with PMR was diagnosed. After low-dose prednisolone (10 mg/day) treatment, the muscle pain disappeared, acute phase reactants decreased and hematuria and proteinuria improved. The renal complication of PMR is rare but important to be considered early in the right clinical context.
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Affiliation(s)
- Eri Takeshima
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-shi, Japan
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Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are clinical diagnoses without “gold standard” serological or histological tests, excluding temporal artery biopsy for GCA. Further, other conditions may mimic GCA and PMR. Treatment with 10–20 mg of prednisolone daily is suggested for PMR or 40–60 mg daily for GCA when temporal arteritis is suspected. This ocular involvement of GCA should be treated as a medical emergency to prevent possible blindness and steroids should be commenced immediately. There are no absolute guidelines as to the dose or duration of administration; the therapeutics of treating this condition and the rate of reduction of prednisolone should be adjusted depending on the individual’s response and with consideration of the multiple risks of high-dose and long-term glucocorticoids. Optimal management may need to consider the role of low-dose aspirin in reducing complications. Clinicians should also be aware of studies that indicate an increased incidence of large-artery complications with GCA. This clinical area requires further research through future development of radiological imaging to aid the diagnosis and produce a clearer consensus relating to diagnosis and treatment.
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A case of type 2 diabetes with polymyalgia rheumatica accompanied by marked prothrombin time-international normalized ratio elongation. Diabetol Int 2011. [DOI: 10.1007/s13340-011-0048-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vasculitides throughout history and their clinical treatment today. Curr Rheumatol Rep 2011; 13:465-72. [PMID: 21904885 DOI: 10.1007/s11926-011-0210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Therapeutic management of the vasculitides is closely linked to modern rheumatologic advances, particularly as it relates to the discovery and first clinical use of glucocorticoids. These compounds were introduced in the late-1940s for the treatment of rheumatoid arthritis, but soon after, clinicians in Europe and the United States realized that they could have a significant positive impact in systemic vasculitides. However, once it was realized that glucocorticoid use was associated with a high degree of morbidity, the search for better immunosuppressive agents with similar efficacy but improved safety profiles was on. During the past several years, several agents have been utilized for the therapeutic management of systemic vasculitides, and the list keeps growing with the development of newer compounds that have retained efficacy but with a better safety profile.
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Breuer GS, Nesher G. What does imaging tell us about polymyalgia rheumatica? Rheumatology (Oxford) 2011; 51:5-6. [DOI: 10.1093/rheumatology/ker193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Polymyalgia Rheumatica. Pain Manag 2011. [DOI: 10.1016/b978-1-4377-0721-2.00045-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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SPIES CORNELIAM, CUTOLO MAURIZIO, STRAUB RAINERH, BURMESTER GERDRÜDIGER, BUTTGEREIT FRANK. More Night Than Day — Circadian Rhythms in Polymyalgia Rheumatica and Ankylosing Spondylitis. J Rheumatol 2010; 37:894-9. [DOI: 10.3899/jrheum.091283] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The circadian rhythm of symptoms in patients with chronic inflammatory diseases is well known. Circadian rhythms could be used to identify targets for time-adapted antiinflammatory therapies, which are administered prior to the flare of cytokine synthesis and inflammatory activity. In recent years, the diurnal variations in rheumatoid arthritis have been described precisely for pain, stiffness, and functional disability, as well as the underlying cyclic variations in hormone levels and cytokine concentrations. This review summarizes the current knowledge on circadian rhythms in other rheumatic diseases, focusing on polymyalgia rheumatica and ankylosing spondylitis.
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Waaler E, Milde EJ. IS THERE A RELATIONSHIP BETWEEN “GIANT CELL” ARTERITIS WITH “POLYMYALGIA RHEUMATICA” AND RHEUMATOID ARTHRITIS? ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1699-0463.1968.tb01349.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bengtsson BA, Malmvall BE. Prognosis of giant cell arteritis including temporal arteritis and polymyalgia rheumatica. A follow-up study on ninety patients treated with corticosteroids. ACTA MEDICA SCANDINAVICA 2009; 209:337-45. [PMID: 7246269 DOI: 10.1111/j.0954-6820.1981.tb11604.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Ninety patients with giant cell arteritis (GCA) were followed 3-10 years after the diagnosis. The mean observation time was 63 months. Thirteen patients died. Corticosteroids were administered to all but one patient; 35 were still on treatment after a mean observation period of 59 months. In 38 patients, 94 flare-ups of the disease were recorded during corticosteroid treatment, most of them occurring during the first year of treatment and when a low dose of prednisolone had been given. Thirty-three relapses, 76% within 3 months, occurred in 28 patients after withdrawal of treatment. One patient relapsed after more than ten years of disease. Polymyalgia rheumatica was the most common symptom of flare-up or relapse, regardless of the clinical picture at the time of diagnosis. The duration of treatment should be individualized. One year of treatment is enough in a few patients, whereas others need steroid therapy for more than four years. The rate of intercurrent disease and complications of GCA or its treatment was low. No patient developed severe eye damage due to GCA. The mortality rate was in fact lower than expected with regard to age and sex.
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Sorensen S, Lorenzen I. Giant-cell arteritis, temporal arteritis and polymyalgia rheumatica. A retrospective study of 63 patients. ACTA MEDICA SCANDINAVICA 2009; 201:207-13. [PMID: 848358 DOI: 10.1111/j.0954-6820.1977.tb15683.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The initial clinical symptoms, the course of the disease, and the effect of corticosteroid treatment have been analyzed in a retrospective study of 63 patients with temporal arteritis or polymyalgia rheumatica. The relationship between the physical examination of the temporal regions, the ophthalmological examination, and biopsy from the temporal artery with respect to the diagnostic value were examined. Histological examination of biopsy specimens from the temporal artery in 58 patients revealed arteritis in 46. Half of the patients had only local symptoms from the temporal regions; one fourth presented such symptoms as well as myalgias, and one fourth had myalgias only. Patients presenting local symptoms of temporal arteritis as well as of myalgias had always had myalgias as the initial symptom and developed local symptoms of temporal arteritis 1-24 months later. Permanent reduction of vision occurred in 20% of the patients. Symptoms of generalized arteritis were observed in several patients. The overlapping of the clinical symptoms, the positive biopsy findings in patients with polymyalgia rheumatica as the only local symptom and the identical reaction to corticosteroid treatment support the conception of temporal arteritis and polymyalgia rheumatica as two manifestations of the same disease. The physical and the ophthalmological examinations were of limited diagnostic value. Positive biopsy findings were seen in 25 patients with noraml palpatory findings, and in 46 patients without eye symptoms the ophthalmoscopic examination revealed no signs of arteritis. If the first biopsy from the temporal artery is negative, biopsy from the contralateral temporal artery should be performed. Correctly timed corticosteroid treatment in adequate doses can prevent reduction of vision in giant-cell arteritis. The treatment is a long-term therapy, its average duration in the present study being more than two years.
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Tallgren LG, Knorring J. RENAL VASCULAR INVOLVEMENT IN A CASE OF POLYMYALGIA RHEUMATIC A WITH TEMPORAL ARTERITIS. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.0954-6820.1969.tb07358.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernández-Rodríguez J, Font C, García-Martínez A, Espígol-Frigolé G, Sanmartí R, Cañete JD, Grau JM, Cid MC. Development of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica: study of a series of 100 patients. Medicine (Baltimore) 2007; 86:233-241. [PMID: 17632265 DOI: 10.1097/md.0b013e318145275c] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several studies suggest that patients with giant cell arteritis (GCA) presenting with isolated polymyalgia rheumatica (PMR) with no cranial symptoms are at low risk of suffering GCA-related ischemic events. However, the issue remains controversial. In the current study we assessed the development of ischemic events in a large series of GCA patients who suffered from apparently isolated PMR during the main course of their disease. One hundred GCA patients presenting with PMR only for at least 2 months were selected from among 347 individuals with biopsy-proven GCA. Clinical manifestations and their chronologic appearance before diagnosis were recorded. Seventy-three patients presented with isolated PMR for a median of 8 months (range, 2 mo-5 yr) and later developed cranial symptoms for a median of 3 weeks (range, 0 wk-1 yr), which eventually led to GCA diagnosis (Group 1). The remaining 27 patients, after presenting a self-limiting course of dismissed mild cranial symptoms lasting for a median of 2 weeks (range, 1 wk-4 mo), developed PMR, which was their chief complaint for a median of 3 months (range, 2 mo-1.5 yr) and the reason for medical evaluation (Group 2). Twenty (27.4%) patients in Group 1 suffered disease-related ischemic complications at the time of diagnosis. No patient in Group 2 developed ischemic events. Patients with GCA presenting with apparently isolated PMR are not a benign subset and have a significant risk of developing ischemic complications. Among them, the only patients who appear to be at low risk of developing ischemic events are those in whom a self-limiting episode of cranial symptoms can be recorded.
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Affiliation(s)
- José Hernández-Rodríguez
- From Vasculitis Research Unit, Department of Internal Medicine (JH-R, CF, AGM, GE-F, JMG, MCC) and Department of Rheumatology (RS, JDC), Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Ostojić P, Damjanov N. The scleroderma Assessment Questionnaire (SAQ). A new self-assessment questionnaire for evaluation of disease status in patients with systemic sclerosis. Z Rheumatol 2007; 65:168-75. [PMID: 16501926 DOI: 10.1007/s00393-005-0006-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Accepted: 03/31/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To develop a self-assessment questionnaire and estimate its validity in the evaluation of disease status in patients with systemic sclerosis. PATIENTS AND METHODS The developed questionnaire (SAQ) consists of 23 questions divided into four groups related to symptoms of vascular, respiratory, gastrointestinal and musculoskeletal dysfunction. One hundred and five patients with systemic sclerosis filled in the SAQ. Answers were assessed on a 0-3 scale and Index of Vascular Status (IVS), Index of Respiratory Status (IRS), Index of Gastrointestinal Status (IGS), Index of Musculoskeletal Status (IMMS) and Index of Disease Status (IDS) were calculated. Mann-Whitney and Kruskal-Wallis tests were used to examine the correlation of index score for particular organ system with various disease damage indicators. RESULTS Mean score for IVS was significantly higher in patients with finger-tip ulcers or finger-tip osteolysis than in patients without, and was also higher in patients who had more severe capillary damage. Mean score for IRS was significantly higher in patients with pulmonary fibrosis, also in patients with reduced FVC, DLCO and DLCO/VA. Patients with esophageal hypomotility had a higher mean score for IGS than patients with normal esophageal motility. The mean score for IMSS showed a strong correlation with the skin score and was significantly higher in patients with reduced hand motility, joint contractures, muscle weakness or arthralgia/arthritis. The mean score for IDS was significantly higher in patients who had multisystemic involvement. CONCLUSIONS The Scleroderma Assessment Questionnaire (SAQ) is a sensitive measurement of disease status and level of impairment of different organ systems in patients with systemic sclerosis.
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Affiliation(s)
- P Ostojić
- Institute of Rheumatology, School of Medicine, University of Belgrade.
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Hazleman BL. Polymyalgia Rheumatica. Pain Manag 2007. [DOI: 10.1016/b978-0-7216-0334-6.50045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Abstract
Polymyalgia rheumatica (PMR) is a common disorder in the elderly population. The diagnosis is based upon recognition of a clinical syndrome, consisting of pain and stiffness in the shoulder and pelvic girdle, muscle tenderness of the upper and lower limbs and nonspecific somatic complaints. In addition, in most cases the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentration are highly elevated. Although PMR and giant cell arteritis (GCA) are commonly regarded as two clinical variations of the same disease, their clinical picture is quite different. Whilst in PMR the musculoskeletal symptoms predominate, the major features of GCA are arterial inflammation and its consequences, which suggests clinical and pathological discrepancies between the two syndromes and important differences with respect to morbidity and mortality. The prognosis of correctly diagnosed PMR is excellent. It is well known that corticosteroid therapy in PMR usually leads to rapid and dramatic improvement of patients' complaints and returns them to previous functional status. However, prolonged corticosteroid treatment, sometimes for several years, may be necessary to maintain clinical improvement. Despite all the knowledge about the beneficial effects of corticosteroid treatment, data concerning the optimal dosage regimen are lacking. Long-term corticosteroid use can be associated with various adverse events, of which induction of osteoporosis, diabetes mellitus and infection among the worst. A Corticosteroid Side Effect Questionnaire has been shown to dose-dependently detect adverse effects perceived by patients. The European League Against Rheumatism (EULAR) response criteria for PMR comprise a core set of markers for monitoring therapeutic responses in PMR, namely ESR or CRP, the visual analogue scale of patient's pain and physician's global assessment, as well as morning stiffness and the ability to elevate the upper limbs. The PMR-disease activity score has been developed on the basis of EULAR response criteria as a means of expressing disease activity as an absolute number. A score <7 indicates low disease activity, scores 7-17 suggest medium activity, and a score >17 is indicative of high disease activity. The PMR-disease activity score has been proven to be highly correlated with patient's global assessment, patient satisfaction and ESR. It provides an easily applicable and valid tool for disease activity monitoring in patients with PMR. Improved knowledge of disease activity processes, exact monitoring of disease activity and treatment responses, and increased risk-estimation of treatment schedules should ultimately improve the care of patients with PMR.
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Affiliation(s)
- Thomas Nothnagl
- 1st and 2nd Department of Medicine, Centre for Rheumatology, Humanisklinikum Lower Austria, Stockerau, Landstrasse, Austria
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Hunder GG. The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970. Mayo Clin Proc 2006; 81:1071-83. [PMID: 16901030 DOI: 10.4065/81.8.1071] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Giant cell arteritis and polymyalgia rheumatica were described separately more than 100 years ago. However, the original reports of both conditions were neglected for many years. After the article by Horton et al on giant cell arteritis in the 1930s and studies published by others in the 1940s, giant cell arteritis began to be recognized as a specific disease. In the 1950s and 1960s, many of the numerous presentations and complications of giant cell arteritis were recorded. In a somewhat similar fashion, physicians became cognizant of polymyalgia rheumatica only after several independent descriptions in the 1940s and 1950s. The rapid response of both syndromes to glucocorticoid therapy was discovered shortly after cortisone's effect on rheumatoid arthritis was described. The origin of the proximal aching and stiffness in polymyalgia rheumatica was more difficult to understand. The relatively minor findings in the joints on physical examination seemed insufficient to account for the severe discomfort. As the link between polymyalgia rheumatica and giant cell arteritis became apparent, some thought the aching in polymyalgia rheumatica was related to vasculitis. The debate about whether proximal synovitis or vasculitis was the cause of the symptoms continued after 1970. Although the reason these 2 conditions were associated was not considered by 1970, the establishment of the syndromes as clinically linked entities provided the groundwork for further progress in the next decades.
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Affiliation(s)
- Gene G Hunder
- Emeritus Staff Center, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Abstract
Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder of unknown etiology which typically presents with symmetric myalgias in the shoulder and pelvic girdles. Other clinical signs include the rapid onset of symptoms and the almost exclusive manifestation in the elderly population. In around 20% of cases, PMR is associated with giant cell arteritis (GCA). However, new imaging techniques suggest that the prevalence of subclinical GCA (e. g. aortitis) in PMR is probably higher. Acute phase reactants like erythrocyte sedimentation rate and c-reactive protein are usually elevated. Myalgias are accompanied by synovitis and bursitis of the large proximal joints and can be visualized by ultrasound or magnetic resonance imaging. While the diagnosis of GCA can be verified by temporal artery biopsy, pathognomonic findings for PMR like specific autoantibodies are lacking. Typical for PMR is the rapid response to corticosteroids. Usually the therapy needs to be continued for at least 2 years. Due to adverse events in many cases a corticosteroid saving therapy like methotrexate is needed.
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Affiliation(s)
- B Hellmich
- Rheumaklinik Bad Bramstedt and Poliklinik für Rheumatologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck.
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Bird HA, Leeb BF, Montecucco CM, Misiuniene N, Nesher G, Pai S, Pease C, Rovensky J, Rozman B. A comparison of the sensitivity of diagnostic criteria for polymyalgia rheumatica. Ann Rheum Dis 2005; 64:626-9. [PMID: 15769919 PMCID: PMC1755435 DOI: 10.1136/ard.2004.025296] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the performance of the several different diagnostic criteria sets currently in use for polymyalgia rheumatica (PMR). METHODS 213 patients attending eight rheumatological centres in eight different European countries were studied. All had recently been referred and were considered by the senior investigator at each centre, selected because of their experience in treatment of PMR, to have this condition. By use of a standard international proforma, the requisite diagnostic points in each criteria set were sought. Sensitivity for each criterion from each set was then calculated, as well as the sensitivity of each criteria set as a whole. RESULTS Of four criteria sets compared, the Bird (1979) criteria performed best with a sensitivity of 99.5%, and the Hunder (1982) criteria second best, with sensitivity of 93.3%. These both performed significantly better than the two other criteria sets, though each of these was admittedly developed for rather specialised reasons. CONCLUSIONS Although this study compares homogeneity, we suggest the Bird 1979 or Hunder 1982 criteria should be used whenever possible. Studies that have used alternative criteria may have less sensitivity in diagnosis.
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Affiliation(s)
- Carlo Salvarani
- Rheumatology Service, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
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