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Baker JF, Baker DG. H. Ralph Schumacher. Rheum Dis Clin North Am 2024; 50:103-111. [PMID: 37973278 DOI: 10.1016/j.rdc.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Dr Schumacher was a force in rheumatology for more than half a century through his multiple roles as a researcher, clinician, mentor, and educator. He is not likely to be soon forgotten by the rheumatology community; however, it is hoped that this chapter can provide a faithful recollection that will help bring his memory to life for some and that rings true to those who knew him and learned from him.
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Affiliation(s)
- Joshua F Baker
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Daniel G Baker
- Kira Biotech Pty Ltd, Fortitude Valley, Queensland, Australia
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Leão RV, Calich ALG, Calich I, Rodrigues MB, Helito PVP, Amaral DT, Pereira RFB, Correa MFDP. Magnetic resonance imaging findings in patients with polymyalgia rheumatica. Radiol Bras 2022; 55:346-352. [PMID: 36514685 PMCID: PMC9743254 DOI: 10.1590/0100-3984.2021.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Objective To describe the prevalence of magnetic resonance imaging (MRI) findings in patients with the clinical diagnosis of polymyalgia rheumatica (PMR). Materials and Methods Sixteen consecutive patients with untreated PMR, meeting the American College of Rheumatology criteria, underwent MRI examinations of the shoulder(s), hip(s), or both, depending on clinical complaints. Six patients also underwent MRI of the spine. Results We evaluated 24 shoulders, among which we identified subacromial-subdeltoid bursitis in 21 (87.5%), glenohumeral joint effusion in 17 (70.8%), and fluid distention of the long head of the biceps tendon sheath in 15 (62.5%). Peritendinitis and capsular edema were observed in 21 (87.5%) and 17 (70.8%) shoulders, respectively. We also evaluated 17 hips, identifying hip joint effusion in 12 (70.6%), trochanteric bursitis in 11 (64.7%), peritendinitis in 17 (100%), and capsular edema in 14 (82.4%). All six of the patients who underwent MRI of the spine were found to have interspinous bursitis. Conclusion Subacromial-subdeltoid bursitis, glenohumeral joint effusion, and hip joint effusion are common findings in patients with PMR. In addition, such patients appear to be highly susceptible to peritendinitis and capsular edema. There is a need for case-control studies to validate our data and to determine the real impact that these findings have on the diagnosis of PMR by MRI.
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Affiliation(s)
- Renata Vidal Leão
- Hospital Sírio-Libanês, São Paulo, SP, Brazil. , Instituto de Radiologia do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil. ,Correspondence: Dra. Renata Vidal Leão. Department of Radiology,
Hospital Sírio-Libanês. Rua Dona Adma Jafet, 91, Bela Vista. São
Paulo, SP, Brazil, 01308-050.
| | | | | | - Marcelo Bordalo Rodrigues
- Hospital Sírio-Libanês, São Paulo, SP, Brazil. , Instituto de Radiologia do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, SP, Brazil. , Instituto de Radiologia do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo (InRad/HC-FMUSP), São Paulo, SP, Brazil.
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Serling-Boyd N, Wallace Z, Jarolimova J, Arvikar S, Miloslavsky EM. An 80-Year-Old Man With Fevers, Altered Mental Status, and Joint Effusions. Arthritis Care Res (Hoboken) 2020; 72:293-300. [PMID: 31562791 PMCID: PMC7228541 DOI: 10.1002/acr.24082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
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F-18 FDG Uptake Patterns and Disease Activity of Collagen Vascular Diseases-Associated Arthritis. Clin Nucl Med 2011; 36:350-4. [DOI: 10.1097/rlu.0b013e318212c858] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cone LA, Lopez C, O'Connell SJ, Nazemi R, Sneider RE, Denker H. Staphylococcal septic synovitis of the sternoclavicular joint with retrosternal extension. J Clin Rheumatol 2006; 12:187-9. [PMID: 16891922 DOI: 10.1097/01.rhu.0000230477.74693.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bacterial arthritis of the sternoclavicular joint is an uncommon disorder caused by a variety of microorganisms. Both Gram-positive and Gram-negative bacteria have been identified as etiologies of an acute suppurative arthritis, whereas a few other bacteria such as mycobacteria and treponemes have been incriminated in chronic disease of the sternoclavicular joint. We recently treated a patient with staphylococcal synovitis of the sternoclavicular joint, which is the 24th recorded in the literature. His illness was complicated by a retrosternal abscess, soft tissue abscess of the chest, septic bursitis, and lumbosacral discitis. He recovered after 6 weeks of nafcillin therapy without any residual infection. Six previous patients with extension into the substernal space and mediastinum have been described. Staphylococcal infection of the sternoclavicular joint, although usually confined to the joint, can be associated with sepsis and metastatic abscess formation as well as substernal extension even in immunocompetent individuals.
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Affiliation(s)
- Lawrence A Cone
- Eisenhower Medical Center, Rancho Mirage, California 92270, USA.
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Ceccato F, Roverano SG, Papasidero S, Barrionuevo A, Rillo OL, Paira SO. Peripheral Musculoskeletal Manifestations in Polymyalgia Rheumatica. J Clin Rheumatol 2006; 12:167-71. [PMID: 16891918 DOI: 10.1097/01.rhu.0000231381.21179.e6] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate the frequency and characteristics of the peripheral musculoskeletal manifestations in polymyalgia rheumatica (PMR), evaluate if PMR with peripheral synovitis represents a subset with a more severe disease, and examine for clinical and laboratory characteristics at onset of PMR that might later predict rheumatoid arthritis (RA). PATIENTS AND METHODS Patients were diagnosed with PMR according to the 1982 Chuang criteria. Patients were followed up between 1990 and 2002. The following musculoskeletal manifestations at onset and during the follow up were considered: peripheral synovitis, distal extremity swelling with pitting edema, carpal tunnel syndrome, and distal tenosynovitis. RESULTS Thirty-eight of the 74 patients (51%) showed distal musculoskeletal symptoms: 29 (39%) had peripheral synovitis, 4 (5%) presented pitting edema, 4 (5%) experienced carpal tunnel syndrome, and one (1.3%) had distal tenosynovitis. These manifestations resolved completely after corticosteroid therapy was initiated. Peripheral synovitis was oligoarticular and often transient. The joints most frequently involved were the wrist, metacarpophalangeal, and knee. Erythrocyte sedimentation rate (ESR) was normal in 7 patients. When comparing patients with PMR with and without peripheral synovitis, no statistically significant differences were found in the studied variables. Through the first year of follow up, 7 patients fulfilled the American College of Rheumatology 1987 criteria for RA, 2 patients developed giant cell arteritis, and 3 had associated malignancy. Patients who developed RA had statistically significantly increased presence of persistent synovitis and a smaller decrease in mean ESR after treatment with corticosteroids. CONCLUSION Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease. Seven patients who developed criteria for seronegative RA within the first year of follow up had presented statistically significant persistent synovitis compared with those who continued as PMR and also showed a smaller initial decrease in mean ESR after steroid treatment was initiated. The absence of persistent arthritis and the benign course of the arthritis permit the distinction of PMR from other inflammatory arthropathies.
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Shimojima Y, Matsuda M, Gono T, Ishii W, Ikeda SI. Serum amyloid A as a potent therapeutic marker in a refractory patient with polymyalgia rheumatica. Intern Med 2005; 44:1009-12. [PMID: 16258224 DOI: 10.2169/internalmedicine.44.1009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a patient with polymyalgia rheumatica (PMR) who showed a relapse soon after tapering of oral prednisolone. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were quickly normalized after the re-increase in oral prednisolone, and muscle pain and stiffness gradually improved in parallel with a decrease in serum amyloid A (SAA). Flow cytometry simultaneously demonstrated an increase in CD8+CD25+ cells and a decrease in CD4+CD25+ cells and CD4+CD45RA+ cells. When clinical symptoms remain with negative results for CRP and ESR even after the start of corticosteroid treatment, SAA might be a potent therapeutic marker for disease activity in PMR.
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Affiliation(s)
- Yasuhiro Shimojima
- Third Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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Carter JD, Vasey FB, Kanik KS, Valeriano-Marcet J. Polymyalgia Rheumatica and Temporal Arteritis with Sacroiliitis and Osteitis Pubis. J Clin Rheumatol 2001; 7:261-4. [PMID: 17039146 DOI: 10.1097/00124743-200108000-00015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Polymyalgia rheumatica (PMR) and temporal arteritis (TA) have been associated with a seronegative polyarthritis that can mimic rheumatoid arthritis. Sacroiliitis and osteitis pubis are most often encountered in the different types of spondyloarthropathy. However, sacroiliitis and osteitis pubis have rarely been described in patients with polymyalgia rheumatica and temporal arteritis. We present two patients, one with temporal arteritis and the other with polymyalgia rheumatica, who also had many features of a spondyloarthropathy, including sacroiliitis and osteitis pubis. In reviewing the literature, we found 30 other patients with a diagnosis of PMR who also had sacroiliitis and/or osteitis pubis. We propose that the inflammatory arthritis associated with polymyalgia rheumatica and temporal arteritis can involve the axial joints, resembling a spondyloarthropathy. It is important for the clinician to recognize that sacroiliitis and osteitis pubis have been associated with PMR and TA so that their radiographic presence does not dissuade the clinician from making the correct diagnosis.
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Affiliation(s)
- J D Carter
- Division of Rheumatology, University of South Florida, College of Medicine, 12901 Bruce B. Downs Blvd., MDC 81, Tampa, FL 33612, USA
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Mattey DL, Hajeer AH, Dababneh A, Thomson W, González-Gay MA, García-Porrúa C, Ollier WE. Association of giant cell arteritis and polymyalgia rheumatica with different tumor necrosis factor microsatellite polymorphisms. ARTHRITIS AND RHEUMATISM 2000; 43:1749-55. [PMID: 10943865 DOI: 10.1002/1529-0131(200008)43:8<1749::aid-anr11>3.0.co;2-k] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are associated with different tumor necrosis factor (TNF) microsatellite polymorphisms. METHODS Typing of TNF microsatellite polymorphisms was carried out by molecular-based techniques on DNA obtained from a population sample of residents from Lugo, northwestern Spain. A case-control approach was used to compare 136 patients with GCA and/or PMR with 147 ethnically matched controls. The association of disease with TNF microsatellite polymorphisms was investigated using chi-square tests and multivariate logistic regression analyses. RESULTS Different TNF microsatellite associations were found with GCA and PMR. In patients with isolated GCA, the primary association was with TNFa2, which was independent of the GCA associations with HLA-DRB1*0401 and *0101. A negative association was found with TNFa10. In patients with isolated PMR, there was a positive association with TNFb3. This was found to be independent of the HLA-DRB1*13/*14 association in isolated PMR. TNFd4 was negatively associated with isolated PMR. Forward stepwise logistic regression analyses indicated that the strongest association with GCA was provided by the TNFa2 allele, although DRB1*0401 and *0101 were still associated. PMR was primarily associated with TNFb3. A direct comparison of TNF allele frequencies between isolated GCA and isolated PMR indicated that the main difference between these conditions occurred in the frequency of TNFa10. CONCLUSION GCA and PMR in individuals from northwestern Spain are associated with different TNF microsatellite polymorphisms. The primary TNF associations (TNFa2 and TNFb3) appear to influence susceptibility to these conditions independent of any HLA-DRB1 association.
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Affiliation(s)
- D L Mattey
- Staffordshire Rheumatology Centre, Stoke-on Trent, UK
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Mikanowicz CK, Leslie M. POLYMYALGIA RHEUMATICA AND TEMPORAL ARTERITIS. Nurs Clin North Am 2000. [DOI: 10.1016/s0029-6465(22)02457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Affiliation(s)
- C Salvarani
- Servizio di Reumatologica, Azlenda Ospedallera, Arcispedale S Maria Nuova, Reggio Emilla, Italy
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Wilke WS. Large vessel vasculitis (giant cell arteritis, Takayasu arteritis). BAILLIERE'S CLINICAL RHEUMATOLOGY 1997; 11:285-313. [PMID: 9220079 DOI: 10.1016/s0950-3579(97)80047-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Giant cell arteritis and Takayasu arteritis are separate but similar idiopathic diseases clinically characterized by constitutional symptoms, shared surrogate markers of systemic inflammation and indistinguishable granulomatous pan-arteritis of large vessels. This review emphasizes and analyses changing perceptions about the diseases. Recent series suggest that aortic involvement in giant cell arteritis may be more common than was previously appreciated. The case for and against inflammatory arthritis in giant cell arteritis is discussed. Ethnic new geographical variation in Takayasu arteritis-disease expression is reviewed. New philosophies of treatment are presented for both diseases. Prognosis in giant cell arteritis and its relationship to treatment is analysed. The utility of the laboratory for diagnosis and monitoring disease activity is appraised for each.
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Affiliation(s)
- W S Wilke
- Cleveland Clinic Foundation, Department of Rheumatic and Immunologic Diseases, OH 44195, USA
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Abstract
Giant cell arteritis and polymyalgia rheumatica are linked conditions that frequently occur in the same patient. They are more common in northern Europe and persons of European descent than in other populations. Recent investigations have begun to provide information about the pathogenesis of both syndromes. Both respond to corticosteroids but at different dose levels. Although a number of vascular complications may occur, the outlook is excellent.
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Affiliation(s)
- G G Hunder
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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Herrera B, Sanmartí R, Ponce A, Lopez-Soto A, Muñoz-Gómez J. Carpal tunnel syndrome heralding polymyalgia rheumatica. Scand J Rheumatol 1997; 26:222-4. [PMID: 9225880 DOI: 10.3109/03009749709065686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Presenting symptoms in polymyalgia rheumatica (PMR) may be atypical. We report herein two old females who developed a bilateral carpal tunnel syndrome several months before the typical symptoms of PMR appeared. In both patients the diagnosis of PMR was overlooked and a surgical release of the median nerve was performed. PMR should be considered in elderly people who develop an acute or subacute carpal tunnel syndrome.
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Affiliation(s)
- B Herrera
- Rheumatology Department, Hospital Clínic i Provincial de Barcelona, Spain
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Uddhammar A, Sojka BN, Rantapää-Dahlqvist S. HLA antigens in polymyalgia rheumatica in northern Sweden. Clin Rheumatol 1996; 15:486-90. [PMID: 8894363 DOI: 10.1007/bf02229647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The HLA-A, B and DR antigens were analyzed with serological methods in 75 patients with polymyalgia rheumatica (PMR). In PMR patients the frequency of the HLA-DR4 antigen was significantly higher (62.1%) compared to blood donors (40%), p < 0.05, but did not differ from patients with seropositive rheumatoid arthritis (RA) from the same area (63.1%). In contrast, the frequency of HLA-B27 in the PMR patients (9.3%) was significantly lower compared to RA (27.2%), p < 0.01, but did not differ from blood donors (16.9%). There was no association between DR4 and disease affliction or severity in PMR. The increased frequency of HLA-B27 in RA but not in PMR in the population of northern Sweden suggests an immunogenetic difference between these two HLA-DR4 associated diseases.
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Affiliation(s)
- A Uddhammar
- Department of Rheumatology, University Hospital of Northern Sweden, Umeå, Sweden
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Meliconi R, Pulsatelli L, Uguccioni M, Salvarani C, Macchioni P, Melchiorri C, Focherini MC, Frizziero L, Facchini A. Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment. ARTHRITIS AND RHEUMATISM 1996; 39:1199-207. [PMID: 8670331 DOI: 10.1002/art.1780390719] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To investigate the immunologic features of synovitis in patients with polymyalgia rheumatica (PMR) and to assess the modifications induced by corticosteroids. METHODS Arthroscopic biopsies of shoulder synovium were obtained from 12 patients with untreated PMR and from 7 patients with PMR that had been treated. Immunohistochemistry was performed on frozen sections utilizing a panel of monoclonal antibodies and computerized image analysis. RESULTS Synovitis was present in 10 of 12 (83%) untreated patients and in only 2 of 7 (29%) treated patients. The synovitis was characterized by vascular proliferation and leukocyte infiltration. Infiltrating cells consisted predominantly of macrophages and T Lymphocytes. Almost all T lymphocytes were CD45RO positive. A few neutrophils, but no B cells, natural killer cells, or gamma/delta T cells were found. Intense expression of HLA class II antigens (DR moreso than DP moreso than DQ) was found in the lining layer cells as well as in macrophages and lymphocytes. DR, but not DP or DQ, was expressed by the endothelium of a few vessels. Class II antigen expression correlated with the number of macrophages and lymphocytes. Macrophage infiltration of arteriole walls was observed in 1 untreated patient without giant cell arteritis (GCA). In untreated patients, there was a positive correlation between the percentage of infiltrating T cells and the duration of disease. Steroid therapy was associated with a significant reduction in the number of blood vessels and of HLA class II expression. One treated patient who no longer had symptoms of PMR still had active synovitis: a relapse occurred 4 months after the biopsy. CONCLUSION Our findings support the hypothesis that synovitis is a major cause of the musculoskeletal symptoms of PMR. There are immunologic similarities with the vascular inflammation observed in GCA. Corticosteroids act on both the vascular and cellular components of synovitis.
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Salvarani C, Gabriel S, Hunder GG. Distal extremity swelling with pitting edema in polymyalgia rheumatica. Report on nineteen cases. ARTHRITIS AND RHEUMATISM 1996; 39:73-80. [PMID: 8546741 DOI: 10.1002/art.1780390110] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the frequency and clinical characteristics of diffuse distal extremity swelling with pitting edema occurring in polymyalgia rheumatica (PMR). METHODS Clinical features and laboratory findings were recorded for all 245 residents of Olmsted County, Minnesota who developed PMR over a 22-year period (1970-1991). Those who exhibited > or = 1 episode of diffuse distal extremity edema with pitting were selected for this study, and were evaluated further. RESULTS Thirteen women and 6 men in this incidence cohort of PMR had > or = 1 episode of distal extremity swelling with pitting edema. Giant cell arteritis was also identified in 5 patients. In 11 patients, the swelling and edema development concurrently with proximal PMR symptoms. In 2 patients, the distal swelling was the initial manifestation, and in 6 patients, the distal symptoms developed during relapses or recurrences of PMR. Both upper and lower extremities were affected, usually in a symmetric manner. Other peripheral manifestations were also common. The distal swelling and pitting edema responded promptly to corticosteroids, and slowly or incompletely to nonsteroidal anti-inflammatory drugs; a similar response was observed in the proximal symptoms. The distal swelling appeared to represent tenosynovitis and synovitis of regional structures. CONCLUSION Distal extremity swelling with pitting edema represents a manifestation of PMR that has not been well described in previous studies. Awareness of this finding will help facilitate the proper diagnosis and institution of appropriate therapy for this disease.
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Affiliation(s)
- C Salvarani
- Mayo Clinic, Rochester, Minnesota 55905, USA
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Start RD, Potter D, Stephenson TJ, Bickerstaff D. Synovial giant cell arteritis. Histopathology 1994; 24:579-81. [PMID: 8063288 DOI: 10.1111/j.1365-2559.1994.tb00580.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- R D Start
- Department of Pathology, University of Sheffield Medical School, UK
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Simms RW, Zerbini CAF. Rheumatic Disease in the Intensive Care Unit: Acute Septic Arthritis and Giant-Cell Arteritis. J Intensive Care Med 1993. [DOI: 10.1177/088506669300800601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Robert W. Simms
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
| | - Cristiano A. F. Zerbini
- Arthritis Section, Boston University School of Medicine, Department of Medicine, and Thorndike Memorial Laboratories, Boston City Hospital, Boston, MA
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Healey LA. Relation of giant cell arteritis to polymyalgia rheumatica. BAILLIERE'S CLINICAL RHEUMATOLOGY 1991; 5:371-8. [PMID: 1807815 DOI: 10.1016/s0950-3579(05)80059-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Polymyalgia rheumatica and temporal arteritis appear to be separate syndromes rather than two manifestations of an underlying giant cell arteritis. Polymyalgia rheumatica is a synovitis that may be persistent or recurrent, while temporal arteritis is almost always a single episode; documented recurrences are rare. The two syndromes frequently occur in the same patient although not necessarily at the same time and they may be separated by a long interval. In some patients with polymyalgia rheumatica, giant cell arteritis is found on biopsy of an asymptomatic temporal artery. The frequency of this concurrence is variable in different populations. It is high in Scandinavia, low in Israel and intermediate between these extremes in other populations that have been studied.
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Ashton-Key M, Gallagher PJ. Surgical pathology of cranial arteritis and polymyalgia rheumatica. BAILLIERE'S CLINICAL RHEUMATOLOGY 1991; 5:387-404. [PMID: 1807817 DOI: 10.1016/s0950-3579(05)80061-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In both clinical and histological terms cranial arteritis is one of the most distinctive of all vascular disorders. The dense granulomatous inflammatory infiltrates which characterize the acute stages of the disease resemble those of Takayasu's arteritis or granulomatous angiitis of the central nervous system, but the clinicopathological features in patients with positive temporal artery biopsies are diagnostic. Well over a third of patients with classical signs and symptoms of cranial arteritis have negative temporal artery biopsies, and focal involvement of arteries of the head and neck is the probable explanation for this. Pathologists should be aware of the wide spectrum of histological changes that occur in muscular arteries as part of normal ageing and must not interpret these as evidence of healed arteritis. The histological changes of healed arteritis include medial chronic inflammation with ingrowth of new blood vessels, focal medial scarring and a bizarre pattern of intimal fibrosis. Although ultrastructural and immunohistochemical studies have provided some insight into the underlying pathological changes, they have not contributed directly to the diagnosis of cranial arteritis. Between 15 and 55% of patients with polymyalgia rheumatica have positive temporal artery biopsies, but apart from an elevated ESR there are no other laboratory investigations or biopsy procedures that contribute to diagnosis.
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Kyle V, Tudor J, Wraight EP, Gresham GA, Hazleman BL. Rarity of synovitis in polymyalgia rheumatica. Ann Rheum Dis 1990; 49:155-7. [PMID: 2322025 PMCID: PMC1004010 DOI: 10.1136/ard.49.3.155] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The joints of 56 patients with polymyalgia rheumatica were examined for evidence of inflammatory synovitis. x Rays, isotope scans, and thermography supplemented clinical examination. Control sternoclavicular joints were examined at necropsy. Peripheral and axial synovitis were uncommon and the results contrast with the findings of several recent studies.
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Affiliation(s)
- V Kyle
- Department of Rheumatology, Addenbrooke's Hospital, Cambridge
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Fitzcharles MA, Esdaile JM. Atypical presentations of polymyalgia rheumatica. ARTHRITIS AND RHEUMATISM 1990; 33:403-6. [PMID: 2317225 DOI: 10.1002/art.1780330314] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Seventy patients with polymyalgia rheumatica (PMR) were seen at a suburban rheumatology practice from July 1983 to December 1987. Six of these patients presented without the typical limb girdle features associated with PMR. Presenting symptoms included peripheral synovitis or unilateral shoulder pain (3 patients), lower leg pain (3 patients), carpal tunnel syndrome (1 patient), and abdominal pain (1 patient). The disease evolved into the recognizable syndrome of PMR over a period of 2-12 months. We suggest that PMR may present in a variety of guises, or have a "stuttering evolution" to the full syndrome. The presenting manifestations of these atypical cases result from peripheral synovitis and thus represent a variant of the more common subclinical proximal synovitis seen in PMR. Increased clinical awareness of atypical presentations may assist earlier diagnosis and effective treatment.
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Affiliation(s)
- M A Fitzcharles
- Rheumatic Disease Unit, McGill University, Montreal, Quebec, Canada
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Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1988; 31:315-24. [PMID: 3358796 DOI: 10.1002/art.1780310302] [Citation(s) in RCA: 14552] [Impact Index Per Article: 404.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The revised criteria for the classification of rheumatoid arthritis (RA) were formulated from a computerized analysis of 262 contemporary, consecutively studied patients with RA and 262 control subjects with rheumatic diseases other than RA (non-RA). The new criteria are as follows: 1) morning stiffness in and around joints lasting at least 1 hour before maximal improvement; 2) soft tissue swelling (arthritis) of 3 or more joint areas observed by a physician; 3) swelling (arthritis) of the proximal interphalangeal, metacarpophalangeal, or wrist joints; 4) symmetric swelling (arthritis); 5) rheumatoid nodules; 6) the presence of rheumatoid factor; and 7) radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints. Criteria 1 through 4 must have been present for at least 6 weeks. Rheumatoid arthritis is defined by the presence of 4 or more criteria, and no further qualifications (classic, definite, or probable) or list of exclusions are required. In addition, a "classification tree" schema is presented which performs equally as well as the traditional (4 of 7) format. The new criteria demonstrated 91-94% sensitivity and 89% specificity for RA when compared with non-RA rheumatic disease control subjects.
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Affiliation(s)
- F C Arnett
- American Rheumatism Association, Atlanta, GA 30329
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1986. A 65-year-old woman with bilateral pulmonary infiltrates. N Engl J Med 1986; 314:1627-35. [PMID: 3713760 DOI: 10.1056/nejm198606193142507] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Sheehan NJ, Myles AB. Occurrence of polymyalgia rheumatica in rheumatoid arthritis. West J Med 1986. [DOI: 10.1136/bmj.292.6532.1394-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Palmer RG, Prouse PJ, Gumpel JM. Occurrence of polymyalgia rheumatica in rheumatoid arthritis: Authors' reply. West J Med 1986. [DOI: 10.1136/bmj.292.6532.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Davies SV, Murray JA. Amphotericin B, aminoglycosides, and hypomagnesaemic tetany. BRITISH MEDICAL JOURNAL 1986; 292:1395-6. [PMID: 3085862 PMCID: PMC1340396 DOI: 10.1136/bmj.292.6532.1395-b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Omdal R, Husby G. Occurrence of polymyalgia rheumatica in rheumatoid arthritis. West J Med 1986. [DOI: 10.1136/bmj.292.6532.1395-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Polymyalgia rheumatica and temporal arteritis are a clinical syndrome and clinicopathologic entity, respectively. Polymyalgia rheumatica occurs more commonly than temporal arteritis, with approximately half of all patients with temporal arteritis having the polymyalgia rheumatica syndrome. Both conditions are found in the population over 50 years of age and are associated with an elevated ESR. The etiology of both is unclear, although genetic, and potentially, environmental factors may play significant roles. Both conditions respond to corticosteroid therapy, but patients with temporal arteritis require significantly higher doses to control symptoms and to prevent blindness.
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Ginsburg WW, Cohen MD, Hall SB, Vollertsen RS, Hunder GG. Seronegative polyarthritis in giant cell arteritis. ARTHRITIS AND RHEUMATISM 1985; 28:1362-6. [PMID: 4084329 DOI: 10.1002/art.1780281208] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nineteen of 520 patients with biopsy-proven giant cell arteritis were found to have persistent seronegative, symmetric polyarthritis with a mean joint count of 20 (swollen plus tender). In 9 patients in the onset of polyarthritis occurred prior to the diagnosis of giant cell arteritis, 3 had simultaneous onset, and 7 developed polyarthritis within 3 years after the onset of giant cell arteritis. Ten of the 19 patients demonstrated radiographic features of joint space narrowing and/or erosions. In 1 patient in a synovial biopsy was performed, revealing marked multinucleated giant cell infiltration. A persistent seronegative polyarthritis, although uncommon in giant cell arteritis, may be its presenting symptom. Other symptoms of giant cell arteritis should be sought in patients who exhibit this feature, especially in those whose arthritis begins at age 50 or older.
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