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Nielsen AW, Hansen IT, Nielsen BD, Kjær SG, Blegvad-Nissen J, Rewers K, Sørensen CM, Hauge EM, Gormsen LC, Keller KK. The effect of prednisolone and a short-term prednisolone discontinuation for the diagnostic accuracy of FDG-PET/CT in polymyalgia rheumatica-a prospective study of 101 patients. Eur J Nucl Med Mol Imaging 2024; 51:2614-2624. [PMID: 38563881 PMCID: PMC11224098 DOI: 10.1007/s00259-024-06697-8] [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: 12/18/2023] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE 2-[18F]Fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) has been suggested as an imaging modality to diagnose polymyalgia rheumatica (PMR). However, the applicability of FDG-PET/CT remains unclear, especially following glucocorticoid administration. This study aimed to investigate the diagnostic accuracy of FDG-PET/CT before and during prednisolone treatment, as well as following short-term prednisolone discontinuation. METHODS Treatment naïve suspected PMR patients were clinically diagnosed at baseline and subsequently had an FDG-PET/CT performed. Patients diagnosed with PMR were administered prednisolone following the first FDG-PET/CT and had a second FDG-PET/CT performed after 8 weeks of treatment. Subsequently, prednisolone was tapered with short-term discontinuation at week 9 followed by a third FDG-PET/CT at week 10. An FDG-PET/CT classification of PMR/non-PMR was applied, utilizing both the validated Leuven score and a dichotomous PMR score. The final diagnosis was based on clinical follow-up after 1 year. RESULTS A total of 68 and 27 patients received a final clinical diagnosis of PMR or non-PMR. A baseline FDG-PET/CT classified the patients as having PMR with a sensitivity/specificity of 86%/63% (Leuven score) and 82%/70% (dichotomous score). Comparing the subgroup of non-PMR with inflammatory diseases to the PMR group demonstrated a specificity of 39%/54% (Leuven/dichotomous score). After 8 weeks of prednisolone treatment, the sensitivity of FDG-PET/CT decreased to 36%/41% (Leuven/dichotomous score), while a short-term prednisolone discontinuation increased the sensitivity to 66%/60%. CONCLUSION FDG-PET/CT has limited diagnostic accuracy for differentiating PMR from other inflammatory diseases. If FDG-PET/CT is intended for diagnostic purposes, prednisolone should be discontinued to enhance diagnostic accuracy. TRIAL REGISTRATION ClinicalTrials.gov (NCT04519580). Registered 17th of August 2020.
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Affiliation(s)
- Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Internal Medicine, Horsens Regional Hospital, Horsens, Denmark
| | - Søren Geill Kjær
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | - Kate Rewers
- Department of Nuclear Medicine and PET, Odense University Hospital, Odense, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Christian Gormsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Led- Og Bindevævssygdomme, Palle Juul-Jensens Boulevard 59, 8200, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ahmed SB, Ahmad S, Pan H. Case Report and Literature Review of an Atypical Polymyalgia Rheumatica and Its Management. Int Med Case Rep J 2023; 16:873-885. [PMID: 38163043 PMCID: PMC10757773 DOI: 10.2147/imcrj.s440486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/07/2023] [Indexed: 01/03/2024] Open
Abstract
Polymyalgia rheumatica (PMR) is a systemic inflammatory disease of the elderly population that increases in incidence as age advances. It is characterised by the sudden or sub-acute onset of symptoms affecting the shoulder and pelvic girdles, often accompanied by constitutional symptoms. Due to the lack of consensual diagnostic criteria and specific laboratory or radiological investigations for PMR, its diagnosis can be very challenging, particularly because it can be mimicked or masked by other geriatric syndromes. PMR responds well to glucocorticoid treatment, but if left untreated, can lead to morbidity and poor quality of life. We present the case of an 87-year-old male who presented with a one-week history of localised pain in the left hip joint, later involving the contralateral hip. Previously able to ambulate unaided, his mobility was now severely impaired. Due to his Alzheimer's dementia and multiple comorbid geriatric conditions, extensive investigations were undertaken before a diagnosis of atypical PMR was reached. Treatment with a low dose of prednisolone led to a full recovery. This case highlights the inconsistency between an atypical presentation and the classic presentation of PMR and draws attention to the possibility of missed diagnosis in older, frail patients. Atypical symptomatology on top of cognitive impairment and language barriers can be easily overlooked and left untreated and could lead to severe adverse outcomes. Accurate diagnosis is crucial, as PMR is readily diagnosed, but the treatment with glucocorticoids, though generally straightforward, can pose challenges, particularly when dealing with polypharmacy and multiple coexisting health conditions.
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Affiliation(s)
- Saad Bilal Ahmed
- Monash Health Rehabilitation and Aged Care Services, Melbourne, Australia
| | - Saara Ahmad
- Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Hanmei Pan
- Monash Health Rehabilitation and Aged Care Services, Melbourne, Australia
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Nielsen AW, Hemmig AK, de Thurah A, Schmidt WA, Sattui SE, Mackie SL, Brouwer E, Dejaco C, Keller KK, Mukhtyar CB. Early referral of patients with suspected polymyalgia rheumatica - A systematic review. Semin Arthritis Rheum 2023; 63:152260. [PMID: 37639896 DOI: 10.1016/j.semarthrit.2023.152260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Prompt diagnosis and treatment of polymyalgia rheumatica (PMR) is crucial to prevent long-term complications and improve patient outcomes. However, there is currently no standardized approach to referral of suspected PMR patients to rheumatologists, leading to inconsistent management practices. The objective of this systematic review was to clarify the existing evidence regarding the following aspects of early management strategies in patients with suspected PMR: diagnostic strategies, GCA screening, glucocorticoid initiation prior to referral, value of shared care and value of fast track clinic. METHODS Two authors performed a systematic literature search, data extraction and risk of bias assessment independently. The literature search was conducted in Embase, MEDLINE (PubMed) and Cochrane. Studies were included if they contained cohorts of suspected PMR patients and evaluated the efficacy of different diagnostic strategies for PMR, screening for giant cell arteritis (GCA), starting glucocorticoids before referral to secondary care, shared care, or fast-track clinics. RESULTS From 2,437 records excluding duplicates, 14 studies met the inclusion criteria. Among these, 10 studies investigated the diagnostic accuracy of various diagnostic strategies with the majority evaluating different clinical approaches, but none of them showed consistently high performance. However, 4 studies on shared care and fast-track clinics showed promising results, including reduced hospitalization rates, lower starting doses of glucocorticoids, and faster PMR diagnosis. CONCLUSION This review emphasizes the sparse evidence of early management and referral strategies for patients with suspected PMR. Additionally, screening and diagnostic strategies for differentiating PMR from other diseases, including concurrent GCA, require clarification. Fast-track clinics may have potential to aid patients with PMR in the future, but studies will be needed to determine the appropriate pre-referral work-up.
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Affiliation(s)
- A W Nielsen
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - A K Hemmig
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - A de Thurah
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - W A Schmidt
- Medical Centre for Rheumatology, Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie Berlin-Buch, Immanuel Krankenhaus, Berlin, Germany
| | - S E Sattui
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (S.E.S.)
| | - S L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, and NIHR Leeds Biomedical Research Centre, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Brouwer
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria; Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - K K Keller
- Department of Rheumatology, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - C B Mukhtyar
- Vasculitis service, Rheumatology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
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Keller KK, Mukhtyar CB, Nielsen AW, Hemmig AK, Mackie SL, Sattui SE, Hauge EM, Dua A, Helliwell T, Neill L, Blockmans D, Devauchelle-Pensec V, Hayes E, Venneboer AJ, Monti S, Ponte C, De Miguel E, Matza M, Warrington KJ, Byram K, Yaseen K, Peoples C, Putman M, Lally L, Finikiotis M, Appenzeller S, Caramori U, Toro-Gutiérrez CE, Backhouse E, Oviedo MCG, Pimentel-Quiroz VR, Keen HI, Owen CE, Daikeler T, de Thurah A, Schmidt WA, Brouwer E, Dejaco C. Recommendations for early referral of individuals with suspected polymyalgia rheumatica: an initiative from the international giant cell arteritis and polymyalgia rheumatica study group. Ann Rheum Dis 2023:ard-2023-225134. [PMID: 38050004 DOI: 10.1136/ard-2023-225134] [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: 10/12/2023] [Accepted: 11/14/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To develop international consensus-based recommendations for early referral of individuals with suspected polymyalgia rheumatica (PMR). METHODS A task force including 29 rheumatologists/internists, 4 general practitioners, 4 patients and a healthcare professional emerged from the international giant cell arteritis and PMR study group. The task force supplied clinical questions, subsequently transformed into Population, Intervention, Comparator, Outcome format. A systematic literature review was conducted followed by online meetings to formulate and vote on final recommendations. Levels of evidence (LOE) (1-5 scale) and agreement (LOA) (0-10 scale) were evaluated. RESULTS Two overarching principles and five recommendations were developed. LOE was 4-5 and LOA ranged between 8.5 and 9.7. The recommendations suggest that (1) each individual with suspected or recently diagnosed PMR should be considered for specialist evaluation, (2) before referring an individual with suspected PMR to specialist care, a thorough history and clinical examination should be performed and preferably complemented with urgent basic laboratory investigations, (3) individuals with suspected PMR with severe symptoms should be referred for specialist evaluation using rapid access strategies, (4) in individuals with suspected PMR who are referred via rapid access, the commencement of glucocorticoid therapy should be deferred until after specialist evaluation and (5) individuals diagnosed with PMR in specialist care with a good initial response to glucocorticoids and a low risk of glucocorticoid related adverse events can be managed in primary care. CONCLUSIONS These are the first international recommendations for referral of individuals with suspected PMR, which complement the European Alliance of Associations for Rheumatology/American College of Rheumatology management guidelines for established PMR.
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Affiliation(s)
- Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Andreas Wiggers Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Sarah Louise Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sebastian Eduardo Sattui
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Anisha Dua
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Toby Helliwell
- School of Medicine, University of Staffordshire, Stafford, UK
| | - Lorna Neill
- Patient Charity Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Dundee, UK
| | - Daniel Blockmans
- Clinical Department of General Internal Medicine Department, Research Department of Microbiology and Immunology, Laboratory of Clinical Infectious and Inflammatory Disorders, University Hospitals Leuven, Leuven, Belgium
- Universitaire Ziekenhuis Gasthuisberg, Leuven, Belgium
| | | | - Eric Hayes
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Jansen Venneboer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sara Monti
- Rheumatology, Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Cristina Ponte
- Rheumatology, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal
| | | | - Mark Matza
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Kevin Byram
- Vanderbilt Rheumatology, Vanderbilt Health, Nashville, Tennessee, USA
| | - Kinanah Yaseen
- Orthopedic and Rheumatologic Insitute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine Peoples
- Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael Putman
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lindsay Lally
- Hospital for Special Surgery, New York, New York, USA
| | - Michael Finikiotis
- University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Simone Appenzeller
- Departamento de Clínica Médica, Facultade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Ugo Caramori
- Department of Public Health, State University of Campinas, Campinas, Brazil
| | - Carlos Enrique Toro-Gutiérrez
- Reference Center in Osteoporosis, Rheumatology & Dermatology, Pontificia Universidad Javeriana Cali Facultad de Ciencias de la Salud, Cali, Colombia
| | | | | | | | | | - Claire Elizabeth Owen
- Rheumatology, Austin Health, Heidelberg, Victoria, Australia
- Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Daikeler
- Clinic for Rheumatology, University Hospital, Basel, Switzerland
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Elisabeth Brouwer
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christian Dejaco
- Rheumatology, Brunico Hospital, Brunico, Italy
- Rheumatology, Medical University of Graz, Graz, Austria
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Espígol-Frigolé G, Dejaco C, Mackie SL, Salvarani C, Matteson EL, Cid MC. Polymyalgia rheumatica. Lancet 2023; 402:1459-1472. [PMID: 37832573 DOI: 10.1016/s0140-6736(23)01310-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 10/15/2023]
Abstract
Polymyalgia rheumatica is an inflammatory disease producing pain and stiffness, mainly in the shoulders and pelvic girdle, in people older than 50 years. Elevation of acute phase reactants is common due to the inflammatory nature of the disease. Since there are no specific diagnostic tests, diagnosis requires the exclusion of other diseases with similar presentations. Imaging has helped to identify the pathological substrate of polymyalgia rheumatica and it is increasingly used to support clinical diagnosis or to detect coexistent giant cell arteritis. Although polymyalgia rheumatica does not clearly impair survival or organ function, it can have a detrimental effect on quality of life. Glucocorticoids at 12·5-25·0 mg prednisone per day are effective in inducing remission in most individuals but, when tapered, relapses occur in 40-60% of those affected and side-effects are common. Assessment of disease activity can be difficult because pain related to common comorbidities such as osteoarthritis and tendinopathies, can return when glucocorticoids are reduced, and acute phase reactants are increased less during flares in individuals undergoing treatment or might increase for other reasons. The role of imaging in assessing disease activity is not yet completely defined. In the search for more efficient and safer therapies, tocilizumab and sarilumab have shown efficacy in randomised controlled trials and additional targeted therapies are emerging. However, judicious risk-benefit balance is essential in applying therapeutic innovations to people with polymyalgia rheumatica.
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Affiliation(s)
- Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria; Department of Rheumatology, Hospital of Brunico (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, Brunico, Italy
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Carlo Salvarani
- Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy; Azienda Ospedaliera-Universitaria di Modena, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Unmet need in the treatment of polymyalgia rheumatica and giant cell arteritis. Best Pract Res Clin Rheumatol 2023; 36:101822. [PMID: 36907732 DOI: 10.1016/j.berh.2023.101822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
For decades, aside from prednisone and the occasional use of immune suppressive drugs such as methotrexate, there was little to offer patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). However, there is a great interest in various steroid sparing treatments in both these conditions. This paper aims to provide an overview of our current knowledge of PMR and GCA, examining their similarities and distinctions in terms of clinical presentation, diagnosis, and treatment, with emphasis placed on reviewing recent and ongoing research efforts on emerging treatment. Multiple recent and ongoing clinical trials are demonstrating new therapeutics that will provide benefit and contribute to the evolution of clinical guidelines and standard of care for patients with GCA and/or PMR.
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Capaccione KM, Valiplackal JP, Huang A, Roa T, Fruauff A, Liou C, Kim E, Khurana S, Maher M, Ma H, Ngyuen P, Mak S, Dumeer S, Lala S, D'souza B, Laifer-Narin S, Desperito E, Ruzal-Shapiro C, Salvatore MM. Checkpoint Inhibitor Immune-Related Adverse Events: A Multimodality Pictorial Review. Acad Radiol 2022; 29:1869-1884. [PMID: 35382975 DOI: 10.1016/j.acra.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
Cancer immunotherapies are drugs that modulate the body's own immune system as an anticancer strategy. Checkpoint inhibitor immunotherapies interfere with cell surface binding proteins that function to promote self-recognition and tolerance, ultimately leading to upregulation of the immune response. Given the striking success of these agents in early trials in melanoma and lung cancer, they have now been studied in many types of cancer and have become a pillar of anticancer therapy for many tumor types. However, abundant upregulation results in a new class of side effects, known as immune-related adverse events (IRAEs). It is critical for the practicing radiologist to be able to recognize these events to best contribute to care for patients on checkpoint inhibitor immunotherapy. Here, we provide a comprehensive system-based review of immune-related adverse events and associated imaging findings. Further, we detail the best imaging modalities for each as well as describe problem solving modalities. Given that IRAEs can be subclinical before becoming clinically apparent, radiologists may be the first provider to recognize them, providing an opportunity for early treatment. Awareness of IRAEs and how to best image them will prepare radiologists to make a meaningful contribution to patient care as part of the clinical team.
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Affiliation(s)
- Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032.
| | - Jacienta P Valiplackal
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Alice Huang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Tina Roa
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Alana Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Connie Liou
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Eleanor Kim
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sakshi Khurana
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Mary Maher
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Pamela Ngyuen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Serena Mak
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Shifali Dumeer
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sonali Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Belinda D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sherelle Laifer-Narin
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Carrie Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
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Concurrent baseline diagnosis of giant cell arteritis and polymyalgia rheumatica - A systematic review and meta-analysis. Semin Arthritis Rheum 2022; 56:152069. [PMID: 35858507 DOI: 10.1016/j.semarthrit.2022.152069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) can be concurrent diseases. We aimed to estimate the point-prevalence of concurrent GCA and PMR. Additionally, an incidence rate (IR) of GCA presenting after PMR diagnosis in patients was estimated. METHODS Two authors performed a systematic literature search, data extraction and risk of bias assessment independently. Studies assessing cohorts of patients presenting with both GCA and PMR were included. The outcomes were point-prevalence of concurrent GCA and PMR and IR for development of GCA after PMR diagnosis. A meta-analysis was performed to calculate a pooled prevalence of concurrent PMR and GCA. RESULTS We identified 29 studies investigating concurrent GCA and PMR. Only two studies applied imaging systematically to diagnose GCA and none to diagnose PMR. GCA presenting after PMR diagnosis was assessed in 12 studies but imaging was not applied systematically. The point-prevalence of concurrent GCA present at PMR diagnosis ranged from 6%-66%. The pooled estimate of the point-prevalence from the meta-analysis was 22%. The point-prevalence of PMR present at GCA diagnosis ranged from 16%-65%. The pooled estimate of the point-prevalence from the meta-analysis was 42%. The IR ranged between 2-78 cases of GCA presenting after PMR per 1000 person-years. CONCLUSION This review and meta-analysis support that concurrent GCA and PMR is frequently present at the time of diagnosis. Additionally, we present the current evidence of GCA presenting in patients after PMR diagnosis. These results emphasize the need for studies applying imaging modalities to diagnose GCA.
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The Combination of 18F-Fluorodeoxyglucose Positron Emission Tomography Metabolic and Clinical Parameters Can Effectively Distinguish Rheumatoid Arthritis and Polymyalgia Rheumatic. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:9614678. [PMID: 35494209 PMCID: PMC9017536 DOI: 10.1155/2022/9614678] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate 18F-fluorodeoxyglucose positron emission tomography (18FDG PET) and clinical parameters to differentiate rheumatoid arthritis (RA) and polymyalgia rheumatic (PMR). Patients and Methods. This retrospective study evaluated 54 patients with suspected RA (n = 23) and PMR (n = 31) who underwent 18F-FDG PET/CT before treatment. The complete diagnosis was based on each classification criterion and at least followed up for 6 months. Demographic and clinical data were also collected. Semiquantitative analysis (maximum standardized uptake value, SUVmax) of abnormal 18F-FDG uptake was undertaken at 17 musculoskeletal sites, and two scoring systems (mean reference (liver/control) scores) were evaluated. The differential diagnostic efficacy of each independent parameter was evaluated using the receiver operating characteristic (ROC) curve. Integrated discriminatory improvement (IDI) and bootstrap tests were used to evaluate the improvement in diagnostic efficacy using a combination of multiple parameters. Results The ROC curve analysis of SUVmax indicated that the interspinous ligament showed the highest discriminative diagnostic value (sensitivity, 64.5%; specificity, 78.3%; area under the curve (AUC), 0.764; positive predictive value, 0.800; negative predictive value, 0.621). The combined model with the rheumatoid factor (RF) and metabolic parameters of 18F-FDG PET resulted in the highest AUC of 0.892 and showed significant reclassification by IDI (IDI, 9.51%; 95% confidence interval: 0.021–0.175; P = 0.013). According to the bootstrap test, compared with RF alone, the combination of RF and metabolic parameters showed an improvement in ROC and was statistically significant (P = 0.017). Conclusions The combination of 18F-FDG PET metabolic and clinical parameters can further improve the differential diagnosis of RA and PMR.
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Aoki N, Miyagami T, Shikino K, Yang KS, Naito T. Polymyalgia Rheumatica in a Patient with Pseudogout and Dementia. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933926. [PMID: 34811343 PMCID: PMC8628562 DOI: 10.12659/ajcr.933926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Patient: Female, 88-year-old
Final Diagnosis: Polymyalgia rheumatica
Symptoms: Fever and generalized pain
Medication:—
Clinical Procedure: —
Specialty: Rheumatology
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Affiliation(s)
- Nozomi Aoki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Taiju Miyagami
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University, Chiba, Japan
| | - Kwang-Seok Yang
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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11
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Fast track clinic for early diagnosis of polymyalgia rheumatica: Impact on symptom duration and prednisolone initiation. Joint Bone Spine 2021; 88:105185. [PMID: 33887471 DOI: 10.1016/j.jbspin.2021.105185] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a fast track clinic (FTC) for patients suspected of polymyalgia rheumatica (PMR) regarding symptom duration, prednisolone initiation before rheumatological assessment, number of hospital contacts before diagnosis, and cancer diagnosis. METHODS It is a retrospective cohort study with a one year follow-up period. Patients referred to the FTC (1st August 2016 to 25th June 2019) were compared to a historical cohort of PMR patients (1st August 2014 to 1st August 2016). Referral criteria are: age over 50, symptoms of PMR but not cranial GCA, and increased C-reactive protein. Data were obtained from patient journals. RESULTS Ninety-seven PMR patients in the historical cohort and 113 FTC patients, of whom 83 patients had PMR, were included. The median (interquartile range) number of days from symptom onset until PMR diagnosis were 53 (31-83) days in the FTC versus 80 (58-132) days in the historical cohort (P<0.001). Prednisolone was prescribed before rheumatological assessment to 11% in the FTC versus 42% in the historical cohort (P<0.001). Patients in the FTC had significantly fewer contacts with the hospital before the diagnosis compared with the historical cohort. Four patients in the FTC were diagnosed with a cancer, all of which were found by imaging. CONCLUSION The FTC reduced the time from symptom onset until diagnosis, lowered prednisolone initiation before rheumatological assessment, and resulted in fewer hospital visits. The frequency of cancers was low in patients suspected of PMR and cancers were discovered by imaging.
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Van Hemelen M, Betrains A, Vanderschueren S, Blockmans D. Impact of age at diagnosis in polymyalgia rheumatica: A retrospective cohort study of 218 patients. Autoimmun Rev 2020; 19:102692. [PMID: 33131702 DOI: 10.1016/j.autrev.2020.102692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Polymyalgia rheumatica (PMR) is a common musculoskeletal inflammatory disease that may occur with giant-cell arteritis (GCA) or in an isolated form. While the incidence is highest in the elderly, there is a paucity of data on its presentation, clinical course and response to treatment in younger individuals. METHODS We conducted a retrospective review of 40 patients who were diagnosed with isolated PMR under the age of 60 and 178 patients diagnosed above this age, taking into account clinical and laboratory data and treatment history. RESULTS Patients who were diagnosed at a younger age had lower acute-phase reactant levels at diagnosis but not after initiation of treatment or at the time of relapse. The risk of relapse was lower in the group diagnosed under age 60 (35% vs 55%). Cumulative and maximal glucocorticoid doses, use of glucocorticoid-sparing agents and duration of glucocorticoid treatment, did not differ between the groups. In multivariate analysis, younger age at diagnosis was associated with cervical pain and male gender. CONCLUSION Compared to patients diagnosed above age 60, patients diagnosed with PMR at a younger age have a lower risk of relapse, but similar long-term outcomes with regards to continued need for treatment.
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Affiliation(s)
- Maarten Van Hemelen
- Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Laboratory of Clinical Infectious and Inflammatory Disease, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Laboratory of Clinical Infectious and Inflammatory Disease, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Laboratory of Clinical Infectious and Inflammatory Disease, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Lee KA, Kim HS, Lee SH, Kim HR. Diagnostic performance of the 2012 EULAR/ACR classification criteria for polymyalgia rheumatica in Korean patients. Int J Rheum Dis 2020; 23:1311-1317. [PMID: 32715648 DOI: 10.1111/1756-185x.13923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/08/2020] [Accepted: 07/05/2020] [Indexed: 11/29/2022]
Abstract
AIM This prospective study aimed to evaluate the diagnostic performance of the 2012 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for polymyalgia rheumatica (PMR) compared to that of previous classification/diagnostic criteria in the Korean population. METHOD We consecutively included 77 patients aged ≥50 years presenting with bilateral shoulder pain and elevated acute-phase reactants. All patients were evaluated for fulfillment of each of the 5 different criteria for PMR (Chuang et al, Bird, Jones and Hazleman, Healey, and the EULAR/ACR criteria). At baseline, bilateral ultrasound (US) examinations of the shoulders and hips were performed. Final diagnosis was made by an experienced rheumatologist at the 12-month follow-up. The area under the curve (AUC), sensitivity, and specificity of criteria sets were assessed. RESULTS At the end of follow-up, 38 and 39 patients were diagnosed with PMR and non-PMR including rheumatoid arthritis (RA, n = 20), respectively. The EULAR/ACR classification criteria with US showed the best discriminating capacity (AUC 0.843). Adding US to EULAR/ACR criteria increased specificity from 74.4% to 89.7%, but decreased sensitivity from 89.5% to 78.9%. The two US items of the EULAR/ACR criteria were significantly more frequent in patients with PMR than in controls. However, the second criterion consisting of both shoulders inflamed were similar between PMR (60.5%) and RA (60.0%) groups. CONCLUSION The 2012 EULAR/ACR classification criteria for PMR performed best in classifying PMR from other inflammatory and non-inflammatory disorders with shoulder pain in Asian populations.
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Affiliation(s)
- Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Hyun-Sook Kim
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
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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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Fruth M, Seggewiss A, Kozik J, Martin-Seidel P, Baraliakos X, Braun J. Diagnostic capability of contrast-enhanced pelvic girdle magnetic resonance imaging in polymyalgia rheumatica. Rheumatology (Oxford) 2020; 59:2864-2871. [DOI: 10.1093/rheumatology/keaa014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/19/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
There is currently no diagnostic test for PMR. A characteristic pattern of extracapsular inflammation as assessed by contrast-enhanced MRI (ceMRI) has recently been described in the pelvis of patients with PMR. We aimed to evaluate the performance of inflammatory ceMRI signals at predefined pelvic sites as a diagnostic test for PMR.
Methods
Pelvic MRI scans of patients with pelvic girdle pain (n = 120), including 40 patients with an expert diagnosis of PMR and 80 controls with other reasons for pelvic pain were scored by three blinded radiologists, who evaluated the degree of contrast enhancement at 19 predefined tendinous and capsular pelvic structures. Different patterns of involvement were analysed statistically.
Results
The frequency of bilateral peritendinitis and pericapsulitis including less common sites, such as the proximal origins of the m. rectus femoris and m. adductor longus, differed significantly between PMR cases and controls: 13.4 ± 2.7 vs 4.0 ± 2.3. A cut-off of ≥10 inflamed sites discriminated well between groups (sensitivity 95.8%, specificity 97.1%). Bilateral inflammation of the insertion of the proximal m. rectus femoris or adductor longus tendons together with ≥3 other bilaterally inflamed sites performed even better (sensitivity 100%, specificity 97.5%).
Conclusion
This study confirms that a distinctive MRI pattern of pelvic inflammation (bilateral peritendinitis and pericapsulitis and the proximal origins of the m. rectus femoris and m. adductor longus) is characteristic for PMR. The high sensitivity and specificity of the set of anatomical sites evaluated suggests their clinical usefulness as a confirmatory diagnostic test.
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Camellino D, Giusti A, Girasole G, Bianchi G, Dejaco C. Pathogenesis, Diagnosis and Management of Polymyalgia Rheumatica. Drugs Aging 2020; 36:1015-1026. [PMID: 31493201 DOI: 10.1007/s40266-019-00705-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polymyalgia rheumatica is an inflammatory rheumatic disease of the elderly characterised by pain and stiffness in the neck and pelvic girdle, and is the second most common inflammatory rheumatic condition in this age group, after rheumatoid arthritis. Polymyalgia rheumatica can occur independently or in association with giant cell arteritis, which is the most common form of primary vasculitis. The diagnosis of polymyalgia rheumatica is usually based on clinical presentation and increase of inflammatory markers. There are no pathognomonic findings that can confirm the diagnosis. However, different imaging techniques, especially ultrasonography, can assist in the identification of polymyalgia rheumatica. Glucocorticoids are the cornerstone of the treatment of polymyalgia rheumatica, but they might be associated with different adverse events. A subgroup of patients presents with a refractory disease course and, in these cases, adding methotrexate as a steroid-sparing agent could be useful. In this review, we summarise the latest findings regarding the pathogenesis, diagnosis and management of polymyalgia rheumatica and try to highlight the possible pitfalls, especially in elderly patients.
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Affiliation(s)
- Dario Camellino
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy.
- Autoimmunology Laboratory, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Andrea Giusti
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Giuseppe Girasole
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Gerolamo Bianchi
- Division of Rheumatology, La Colletta Hospital, Azienda Sanitaria Locale 3, Via del Giappone 3, 16011, Arenzano, GE, Italy
| | - Christian Dejaco
- Dienst für Rheumatologie, Servizio di reumatologia, Südtiroler Sanitätsbetrieb, Azienda Sanitaria dell'Alto Adige, Krankenhaus Bruneck, Ospedale di Brunico, Bruneck, Italy
- Department of Rheumatology, Medical University Graz, Graz, Austria
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17
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Fors C, Bergström U, Willim M, Pilman E, Turesson C. Validity of polymyalgia rheumatica diagnoses and classification criteria in primary health care. Rheumatol Adv Pract 2019; 3:rkz033. [PMID: 31660474 PMCID: PMC6799851 DOI: 10.1093/rap/rkz033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/24/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives PMR is an inflammatory disease with prominent morning stiffness and muscular tenderness, usually diagnosed in primary health care (PHC). The objectives were to examine the validity of PMR diagnoses in PHC and to validate the use of classification criteria for PMR. Methods Medical records for patients with a registered PMR diagnosis at two PHC facilities were reviewed. Patients were classified according to several sets of criteria. An independent review, with assessment of the PMR diagnosis, was performed by an experienced rheumatologist. Results Of 188 patients, the PMR diagnosis was in agreement with the independent review in 60% overall, in 84% of those fulfilling a modified version of the ACR/EULAR classification criteria and in 52% of those who did not. The corresponding proportions for the Bird criteria were 66 and 31%, and for the Healey criteria 74 and 42%. In 74% of the medical records, documentation on morning stiffness was missing. Rheumatoid factor was tested in 22% and anti-CCP antibodies in 15%. Conclusion In this study of patients with PMR diagnosed in PHC, the diagnosis was supported by the independent review in 60% of the patients. Documentation on morning stiffness and testing for autoantibodies were limited. A modified version of the ACR/EULAR criteria can be used to identify patients with a valid PMR diagnosis in retrospective surveys but does not capture all PMR patients. The modified ACR/EULAR criteria may be more stringent than some of the older criteria sets.
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Affiliation(s)
- Charlotta Fors
- Department of Rheumatology, Skåne University Hospital.,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö
| | - Ulf Bergström
- Department of Rheumatology, Skåne University Hospital.,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö
| | - Minna Willim
- Department of Rheumatology, Skåne University Hospital.,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö
| | - Eva Pilman
- Vårdcentralen Landborgen, Helsingborg, Sweden
| | - Carl Turesson
- Department of Rheumatology, Skåne University Hospital.,Rheumatology, Department of Clinical Sciences, Malmö, Lund University, Malmö
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Manzo C, Emamifar A. Polymyalgia Rheumatica and Seronegative Elderly-Onset Rheumatoid Arthritis: Two Different Diseases with Many Similarities. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10313508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Polymyalgia rheumatica (PMR) and seronegative elderly-onset rheumatoid arthritis (SEORA) are two of the most frequent inflammatory rheumatologic diseases in elderly patients. At first presentation, there are many similarities between PMR and SEORA, that may lead to a real diagnostic conundrum. The most relevant similarities and differences between PMR and SEORA are discussed in this review. In addition to the acute involvement of the shoulder joints, important features characterising both diseases are morning stiffness longer than 45 minutes, raised erythrocyte sedimentation rate, and a good response to low doses of prednisone. Some findings (such as erosive arthritis or symmetrical involvement of metacarpophalangeal and/or proximal interphalangeal joints) can help to make the diagnosis of SEORA, whereas shoulder and hip ultrasonography and 18-FDG PET/CT seem to be less specific. However, in several patients only long-term follow-ups confirm the initial diagnosis. A definite diagnosis of PMR or SEORA has significant therapeutic implications, since patients with PMR should be treated with long-term glucocorticoids, and sometimes throughout life, which predisposes the patients to serious side effects. On the contrary, in patients with SEORA, short-term treatment with glucocorticoids should be considered when initiating or changing disease modifying antirheumatic drugs, followed by rapid tapering.
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Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital “Mariano Lauro”, Sant’Agnello, Italy
| | - Amir Emamifar
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Diagnostic Center, Svendborg Hospital, Odense University Hospital, Svendborg, Denmark
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Hayashi K, Ohashi K, Watanabe H, Sada KE, Shidahara K, Asano Y, Asano SH, Yamamura Y, Miyawaki Y, Morishita M, Matsumoto Y, Kawabata T, Wada J. Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis. Ther Adv Musculoskelet Dis 2019; 11:1759720X19864822. [PMID: 31367238 PMCID: PMC6643174 DOI: 10.1177/1759720x19864822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 06/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background: This study aimed to identify the clinical subgroups of polymyalgia rheumatica
(PMR) using cluster analysis and compare the outcomes among the identified
subgroups. Methods: We enrolled patients with PMR who were diagnosed at Okayama University
Hospital, Japan between 2006 and 2017, met the 2012 European League Against
Rheumatism/American College of Rheumatology provisional classification
criteria for PMR, and were treated with glucocorticoids. Hierarchical
cluster analysis using variables selected by principal component analysis
was performed to identify the clusters. Subsequently, the outcomes among the
identified clusters were compared in the study. The primary outcome was
treatment response at 1 month after commencement of treatment. The secondary
outcome was refractory clinical course, which was defined as the requirement
of additional treatments or relapse during a 2-year observational
period. Results: A total of 61 consecutive patients with PMR were enrolled in the study. Their
mean age was 71 years, and 67% were female. Hierarchical cluster analysis
revealed three distinct subgroups: cluster 1 (n = 14) was
characterized by patients with thrombocytosis (all patients showed a
platelet count of >45 × 10⁴/µl), cluster 2 (n = 38), by
patients without peripheral arthritis, and cluster 3
(n = 9), by patients with peripheral arthritis. The
patients in cluster 1 achieved treatment response less frequently than those
in cluster 2 (14% versus 47%, p = 0.030).
Refractory cases were more frequent in cluster 1 than in cluster 2; however,
no significant difference was noted (71% versus 42%,
p = 0.06). Conclusions: Thrombocytosis could predict the clinical course in patients with PMR.
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Affiliation(s)
- Keigo Hayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Keiji Ohashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Haruki Watanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Ken-Ei Sada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan
| | - Kenta Shidahara
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yosuke Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Sumie Hiramatsu Asano
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yuriko Yamamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yoshia Miyawaki
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Michiko Morishita
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Yoshinori Matsumoto
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Tomoko Kawabata
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan
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Laporte JP, Garrigues F, Huwart A, Jousse-Joulin S, Marhadour T, Guellec D, Cornec D, Devauchelle-Pensec V, Saraux A. Localized Myofascial Inflammation Revealed by Magnetic Resonance Imaging in Recent-onset Polymyalgia Rheumatica and Effect of Tocilizumab Therapy. J Rheumatol 2019; 46:1619-1626. [PMID: 30877202 DOI: 10.3899/jrheum.180958] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the prevalence of myofascial inflammatory lesions visible by magnetic resonance imaging (MRI) and their changes after tocilizumab (TCZ) therapy in active polymyalgia rheumatica (PMR). METHODS We conducted a posthoc analysis of data from the TENOR study of TCZ monotherapy in PMR. The 18 patients each received TCZ injections at weeks 0, 4, and 8. The shoulder and pelvic girdles were assessed at baseline then at weeks 2 and 12 using T1- and T2- short-tau inversion recovery-weighted MRI. Radiologists blinded to patient data assessed each muscle group for localized myofascial inflammation on baseline, Week 2, and Week 12 MRI. Reproducibility was estimated by having 2 radiologists assess the Week 2 MRI of 13 patients, then computing the κ coefficient. RESULTS For myofascial lesion detection, intraobserver reproducibility was almost perfect (κ = 0.890) and interobserver reproducibility was substantial (κ = 0.758). At baseline, all patients had at least 1 inflammatory myofascial lesion; sites involved were the shoulder in 10 (71.4%) patients, hip in 13 (86.7%), ischial tuberosity in 9 (60.0%), and pubic symphysis in 12 (80.0%). Sites involved at Week 12 were the shoulder in 8 patients (53.3%), hip in 5 (33.3%), ischial tuberosity in 1, and pubic symphysis in 3 (20.0%). At Week 12, of 103 muscle groups studied in all, 43 (41.7%) had no inflammatory lesions, compared to 33 at baseline (p = 0.002); improvements were noted in 66 (64.1%) muscle groups, worsening in 2 (1.9%), no change in 35 (34.0%; p = 0.034). CONCLUSION Localized myofascial inflammatory lesions are common in recent-onset PMR and improve during TCZ therapy. Clinicaltrials.gov (NCT01713842).
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Affiliation(s)
- Jean-Patrick Laporte
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Florent Garrigues
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Anaïs Huwart
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Sandrine Jousse-Joulin
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Thierry Marhadour
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Dewi Guellec
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Divi Cornec
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Valérie Devauchelle-Pensec
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France.,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest
| | - Alain Saraux
- From the Radiology department, Centre Hospitalier Universitaire (CHU) de Brest; Rheumatology department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU Brest; INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest, Brest, France. .,J.P. Laporte, MD, Radiology department, CHU de Brest; F. Garrigues, MD, Radiology department, CHU de Brest; A. Huwart, MD, Radiology department, CHU de Brest; S. Jousse-Joulin, MD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; T. Marhadour, MD, Rheumatology department, CERAINO, CHU Brest; D. Guellec, MD, Rheumatology department, CERAINO, CHU Brest; D. Cornec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; V. Devauchelle-Pensec, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest; A. Saraux, MD, PhD, Rheumatology department, CERAINO, CHU Brest, and INSERM UMR 1227, Laboratoire d'Immunothérapie et Pathologies lymphocytaires B, Labex Immunotherapy, Graft, Oncology, Université de Brest.
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Park ES, Ahn SS, Jung SM, Song J, Park YB, Lee SW. Application of 2012 EULAR/ACR criteria for polymyalgia rheumatica to Korean patients previously classified by Chuang and Hunder criteria or Healey criteria. Int J Rheum Dis 2018; 21:1838-1843. [PMID: 30168262 DOI: 10.1111/1756-185x.13343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To apply 2012 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) criteria to Korean patients previously classified as polymyalgia rheumatica (PMR) by Chuang and Hunder criteria or Healey criteria and investigated whether they might be still reclassified as PMR or not. METHODS We retrospectively reviewed the medical records of 113 previously classified PMR patients. We applied 2012 EULAR/ACR criteria without ultrasonography to PMR patients, and fulfilment required at least 4 points. We evaluated odds ratios (OR) using logistic regression analyses. RESULTS The mean age was 61.7 years. Seventy-one patients (62.8%) fulfilled Chuang and Hunder criteria, and 113 patients (100%) met Healey criteria. When we applied 2012 EULAR/ACR criteria, 98 patients fulfilled essential items (≥50 years, bilateral shoulder aching and abnormal C-reactive protein or erythrocyte sedimentation rate), and only 80 patients achieved points ≥4. Eight patients fulfilling the criteria exhibited higher frequencies of all the detailed items than those who did not. In multivariate logistic regression analysis, absence of rheumatoid factor or anti-citrullinated peptide antibodies was the only independent contributing item to the fulfilment of 2012 EULAR/ACR criteria (OR 23.571, 95% CI 6.357-87.407, P < .001). When we reclassified 33 excluded patients, the most common newly classified disease was generalized osteoarthritis (24.2%), followed by osteoporosis with compression fracture (15.2%). CONCLUSION Eighty of 113 patients (81.6%) previously classified by Chuang and Hunder criteria or Healey criteria fulfilled 2012 EULAR/ACR criteria for PMR.
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Affiliation(s)
- Eun Seong Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jungsik Song
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Won Lee
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Teixeira M, Greenlund LS. 76-Year-Old Man With New Bilateral Shoulder Pain. Mayo Clin Proc 2018; 93:950-954. [PMID: 29685456 DOI: 10.1016/j.mayocp.2017.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 10/28/2022]
Affiliation(s)
- Miguel Teixeira
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Laura S Greenlund
- Advisor to resident and Consultant in Primary Care Internal Medicine, Rochester, MN
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Owen CE, Poon AMT, Lee ST, Yap LP, Zwar RB, McMenamin CM, Lam SKL, Liew DFL, Pathmaraj K, Kemp A, Scott AM, Buchanan RRC. Fusion of positron emission tomography/computed tomography with magnetic resonance imaging reveals hamstring peritendonitis in polymyalgia rheumatica. Rheumatology (Oxford) 2017; 57:345-353. [DOI: 10.1093/rheumatology/kex411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 11/14/2022] Open
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González-Gay MA, Matteson EL, Castañeda S. Polymyalgia rheumatica. Lancet 2017; 390:1700-1712. [PMID: 28774422 DOI: 10.1016/s0140-6736(17)31825-1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/09/2017] [Accepted: 06/19/2017] [Indexed: 12/12/2022]
Abstract
Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. Vascular uptake on PET scans is seen in some patients. A dose of 12·5-25·0 mg prednisolone daily or equivalent leads to rapid improvement of symptoms in most patients with isolated disease. However, relapses are common when prednisolone is tapered. Methotrexate might be used in patients who relapse. The effectiveness of biological therapies, such as anti-interleukin 6, in patients with polymyalgia rheumatica that is refractory to glucocorticoids requires further investigation. Most population-based studies indicate that mortality is not increased in patients with isolated disease.
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Affiliation(s)
- Miguel A González-Gay
- Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Eric L Matteson
- Division of Rheumatology and Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Santos Castañeda
- Rheumatology Division, Hospital de La Princesa, Instituto de Investigación Sanitaria-Princesa, Universidad Autónoma de Madrid, Madrid, Spain
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Emamifar A, Hess S, Gerke O, Hermann AP, Laustrup H, Hansen PS, Thye-Rønn P, Marcussen N, Svendstrup F, Gildberg-Mortensen R, Bang JC, Farahani ZA, Chrysidis S, Toftegaard P, Andreasen RA, le Greves S, Andersen HR, Olsen RN, Hansen IMJ. Polymyalgia rheumatica and giant cell arteritis-three challenges-consequences of the vasculitis process, osteoporosis, and malignancy: A prospective cohort study protocol. Medicine (Baltimore) 2017; 96:e7297. [PMID: 28658131 PMCID: PMC5500053 DOI: 10.1097/md.0000000000007297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are common inflammatory conditions. The diagnosis of PMR/GCA poses many challenges since there are no specific diagnostic tests. Recent literature emphasizes the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to assess global disease activity in inflammatory diseases. 18F-FDG PET/CT may lead to the diagnosis at an earlier stage than conventional imaging and may also assess response to therapy. With respect to the management of PMR/GCA, there are 3 significant areas of concern as follows: vasculitis process/vascular stiffness, malignancy, and osteoporosis. METHODS AND ANALYSIS All patients with suspected PMR/GCR referred to the Rheumatology section of Medicine Department at Svendborg Hospital, Denmark. The 4 separate studies in the current protocol focus on: the association of clinical picture of PMR/GCA with PET findings; the validity of 18F-FDG PET/CT scan for diagnosis of PMR/GCA compared with temporal artery biopsy; the prevalence of newly diagnosed malignancies in patients with PMR/GCA, or PMR-like syndrome, with the focus on diagnostic accuracy of 18F-FDG PET/CT scan compared with conventional workup (ie, chest X-ray/abdominal ultrasound); and the impact of disease process, and also steroid treatment on bone mineral density, body composition, and vasculitis/vascular stiffness in PMR/GCA patients. ETHICS AND DISSEMINATION The study has been approved by the Regional Ethics Committee of the Region of Southern Denmark (identification number: S-20160098) and Danish Data Protection Agency (J.nr 16/40522). Results of the study will be disseminated via publications in peer-reviewed journals, and presentation at national and international conferences.
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Affiliation(s)
- Amir Emamifar
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg
| | - Søren Hess
- Faculty of Health Sciences, University of Southern Denmark
- Department of Nuclear Medicine, Odense University Hospital, Odense
- Department of Radiology and Nuclear Medicine, Hospital Southwest Jutland, Esbjerg
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense
- Centre of Health Economics Research, University of Southern Denmark
| | | | - Helle Laustrup
- Department of Rheumatology, Odense University Hospital, Odense
| | - Per Syrak Hansen
- Diagnostic center, Odense University Hospital, Svendborg Hospital, Svendborg
| | - Peter Thye-Rønn
- Diagnostic center, Odense University Hospital, Svendborg Hospital, Svendborg
| | | | | | | | - Jacob Christian Bang
- Department of Radiology, Odense University Hospital, Svendborg Hospital, Svendborg
| | | | | | - Pia Toftegaard
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg
| | | | | | - Hanne Randi Andersen
- Patient Research Partner, Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Rudolf Nezlo Olsen
- Patient Research Partner, Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
| | - Inger Marie Jensen Hansen
- Department of Rheumatology, Odense University Hospital, Svendborg Hospital, Svendborg
- Faculty of Health Sciences, University of Southern Denmark
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Abstract
Imaging methods, such as joint and color duplex sonography, magnetic resonance imaging (MRI) and positron emission tomography (PET) nowadays facilitate the diagnosis of polymyalgia rheumatica and large vessel vasculitides and have now been included in the new classification criteria. In patients with typical symptoms, color duplex sonography of the temporal artery can replace a biopsy of the temporal artery for the diagnosis of giant cell arteritis (GCA); however, the role of these methods for patient follow-up and assessment of prognosis is unclear. Polymyalgia rheumatica is treated with glucocorticoids (GC) in an initial dosage of up to 20 mg per day. In patients with large vessel vasculitis higher doses are needed for induction of remission. Furthermore, the rate of relapse and GC-related adverse events are higher in GCA and Takayasu arteritis (TA). Thus, initial GC-sparing treatment with methotrexate or other immunosuppressants is recommended. Recent study data show an effectiveness of biologics. Recent data of the first placebo-controlled proof of concept trials showed that the interleukin-6 antagonist tocilizumab reduces GC requirements and relapse rates in patients with GCA and polymyalgia rheumatica. Both ustekinumab, a monocalonal antibody against interleukin-12/23p40 and the CTLA-4 immunoglobulin abatacept appeared to be effective in recent pilot trials for GCA. Antibodies against tumor necrosis factor alpha (TNF alpha) were ineffective for polymyalgia rheumatica and GCA in placebo-controlled trials but data from open label studies suggested some efficacy in refractory TA.
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Camellino D, Cimmino MA. Are the New ACR/EULAR Criteria the Ultimate Answer for Polymyalgia Rheumatica Classification? J Rheumatol 2016; 43:836-8. [PMID: 27134265 DOI: 10.3899/jrheum.160232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Dario Camellino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy.
| | - Marco A Cimmino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, Genoa, Italy
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