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Sarilumab (Kevzara) for polymyalgia rheumatica. Med Lett Drugs Ther 2024; 66:77-8. [PMID: 38696312 DOI: 10.58347/tml.2024.1702c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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Fruth M, Künitz L, Martin-Seidel P, Tsiami S, Baraliakos X. MRI of shoulder girdle in polymyalgia rheumatica: inflammatory findings and their diagnostic value. RMD Open 2024; 10:e004169. [PMID: 38724260 PMCID: PMC11086571 DOI: 10.1136/rmdopen-2024-004169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Non-synovial inflammation as detected by MRI is characteristic in polymyalgia rheumatica (PMR) with potentially high diagnostic value. OBJECTIVE The objective is to describe inflammatory MRI findings in the shoulder girdle of patients with PMR and discriminate from other causes of shoulder girdle pain. METHODS Retrospective study of 496 contrast-enhanced MRI scans of the shoulder girdle from 122 PMR patients and 374 non-PMR cases. Two radiologists blinded to clinical and demographic information evaluated inflammation at six non-synovial plus three synovial sites for the presence or absence of inflammation. The prevalence of synovial and non-synovial inflammation, both alone and together with clinical information, was tested for its ability to differentiate PMR from non-PMR. RESULTS A high prevalence of non-synovial inflammation was identified as striking imaging finding in PMR, in average 3.4±1.7, mean (M)±SD, out of the six predefined sites were inflamed compared with 1.1±1.4 (M±SD) in non-PMR group, p<0.001, with excellent discriminatory effect between PMR patients and non-PMR cases. The prevalence of synovitis also differed significantly between PMR patients and non-PMR cases, 2.5±0.8 (M±SD) vs 1.9±1.1 (M±SD) out of three predefined synovial sites, but with an inferior discriminatory effect. The detection of inflammation at three out of six predefined non-synovial sites differentiated PMR patients from controls with a sensitivity/specificity of 73.8%/85.8% and overall better performance than detection of synovitis alone (sensitivity/specificity of 86.1%/36.1%, respectively). CONCLUSION Contrast-enhanced MRI of the shoulder girdle is a reliable imaging tool with significant diagnostic value in the assessment of patients suffering from PMR and differentiation to other conditions for shoulder girdle pain.
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Affiliation(s)
- Martin Fruth
- Evidia Radiologie am Rheumazentrum Ruhrgebiet, Herne, Germany
- Rheumazentrum Ruhrgebiet, Ruhr-Universitat Bochum, Herne, Germany
| | - Lucie Künitz
- Rheumazentrum Ruhrgebiet, Ruhr-Universitat Bochum, Herne, Germany
| | | | - Styliani Tsiami
- Rheumazentrum Ruhrgebiet, Ruhr-Universitat Bochum, Herne, Germany
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Tanaka Y, Tanaka S, Fukasawa T, Inokuchi S, Uenaka H, Kimura T, Takahashi T, Kato N. Glucocorticoid treatment and clinical outcomes in patients with polymyalgia rheumatica: A cohort study using routinely collected health data. Joint Bone Spine 2024; 91:105680. [PMID: 38143016 DOI: 10.1016/j.jbspin.2023.105680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVE We aimed to describe the following in patients with polymyalgia rheumatica (PMR): (1) real-world glucocorticoid (GC) therapy, (2) improvement in inflammatory parameters associated with disease activity (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and (3) incidence of GC-related adverse events (AEs). METHODS A cohort study was conducted using a Japanese electronic medical records database. We included newly diagnosed PMR patients aged≥50years with baseline CRP levels≥10mg/L and/or ESR>30mm/h and an initial GC dose of≥5mg/day. The outcomes were GC dose, inflammatory parameters, and GC-related AEs. RESULTS A total of 373 PMR patients (mean age, 77.3 years) were analyzed. The median initial GC dose was 15.0mg/day, which gradually decreased to 3.5mg/day by week 52. The median cumulative GC dose at week 52 was 2455.0mg. The median CRP level on day 0 was 64.3mg/L, which decreased during weeks 4-52 (1.4-3.2mg/L). At week 52, 39.0% of patients had a CRP level>3.0mg/L. The cumulative incidence of GC-related AEs at week 52 was 49.0% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 2.9% for glaucoma, and 4.3% for serious infection. The incidence of osteoporosis and diabetes increased with the GC dose. CONCLUSION The incidence of GC-related AEs was associated with the GC dose in PMR patients. Further research is required to identify treatment strategies that can effectively control PMR disease activity while minimizing GC use.
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Affiliation(s)
- Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka, 807-8555 Japan
| | - Shinichi Tanaka
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2 Yurakucho, Chiyoda-ku, Tokyo, 100-0006 Japan
| | - Toshiki Fukasawa
- Research and Analytics Department, Real World Data Co., Ltd., Shiseido Kyoto Bld.4F, 480, Aburanokojidori Kizuyabashi-sagaru Kitafudondocho Shimogyo-ku kyoto-shi, Kyoto, 600-8233 Japan
| | - Shoichiro Inokuchi
- Research and Analytics Department, Real World Data Co., Ltd., Shiseido Kyoto Bld.4F, 480, Aburanokojidori Kizuyabashi-sagaru Kitafudondocho Shimogyo-ku kyoto-shi, Kyoto, 600-8233 Japan
| | - Hidetoshi Uenaka
- Research and Analytics Department, Real World Data Co., Ltd., Shiseido Kyoto Bld.4F, 480, Aburanokojidori Kizuyabashi-sagaru Kitafudondocho Shimogyo-ku kyoto-shi, Kyoto, 600-8233 Japan
| | - Takeshi Kimura
- Research and Analytics Department, Real World Data Co., Ltd., Shiseido Kyoto Bld.4F, 480, Aburanokojidori Kizuyabashi-sagaru Kitafudondocho Shimogyo-ku kyoto-shi, Kyoto, 600-8233 Japan
| | - Toshiya Takahashi
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2 Yurakucho, Chiyoda-ku, Tokyo, 100-0006 Japan; Specialty Care Medical, Sanofi K.K., 3-20-2, Nishi-Shinjuku, Shinjuku-ku, Tokyo, 163-1488 Japan
| | - Naoto Kato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, 1-1-2 Yurakucho, Chiyoda-ku, Tokyo, 100-0006 Japan.
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Manzo C, Isetta M, Castagna A. Did the first description of patients with polymyalgia rheumatica take place in Scotland or in Denmark? Reumatismo 2024; 76. [PMID: 38523578 DOI: 10.4081/reumatismo.2024.1673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/22/2023] [Indexed: 03/26/2024] Open
Abstract
The first description of polymyalgia rheumatica (PMR) is generally attributed to Dr. Bruce. In an 1888 article entitled Senile rheumatic gout, he described five male patients aged from 60 to 74 years whom he had visited at the Strathpeffer spa in Scotland. In 1945, Dr. Holst and Dr. Johansen reported on five female patients examined over several months at the Medical Department of Roskilde County Hospital in Denmark. These patients suffered from hip, upper arms, and neck pain associated with elevated ESR and constitutional manifestations such as low-grade fever or loss of weight. In the same year, Meulengracht, another Danish physician, reported on two patients with shoulder pain and stiffness associated with fever, weight loss, and an increased erythrocyte sedimentation rate. As in the five patients reported by Dr. Holst and Dr. Johansen, a prolonged recovery time was recorded. On reading and comparing these three accounts, we question whether it is correct to attribute the first description of PMR to Dr. Bruce and put forward shifting this accolade to the three Danish physicians.
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Affiliation(s)
- C Manzo
- Internal and Geriatric Medicine Department, Rheumatology Outpatient Clinic, Health Authority Napoli 3 sud, Sant'Agnello.
| | - M Isetta
- Central and North West London NHS Trust, London.
| | - A Castagna
- Primary Care Department, Catanzaro Provincial Health Authority, Soverato.
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D'Agostino J, Souki A, Lohse A, Carvajal Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel B, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A, Devauchelle-Pensec V. Concordance and agreement between different activity scores in polymyalgia rheumatica. RMD Open 2024; 10:e003741. [PMID: 38490696 PMCID: PMC10946364 DOI: 10.1136/rmdopen-2023-003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs. METHOD Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots. RESULTS A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time. CONCLUSION The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used. TRIAL REGISTRATION NUMBER NTC02908217.
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Affiliation(s)
- Justine D'Agostino
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Aghiles Souki
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Anne Lohse
- Hopital Nord Franche-Comte-Site de Belfort, Belfort, France
| | | | - Emanuelle Dernis
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | - Christophe Richez
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
- UMR CNRS 5164, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Daniel Wendling
- Rheumatology and EA4266 Franche-Comté University, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Eric Toussirot
- INSERM Clinical Investigation Center 1431, Centre Hospitalier Universitaire de Besancon, Besancon, France
- Department of Rheumatology, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Bruno Fautrel
- Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM UMR-S 1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, France
| | - Laurent Chiche
- Internal Medicine, Marseille Public University Hospital System, Marseille, France
| | - Pascal Hilliquin
- Department of Rhumatology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Catherine Le Henaff
- Department of Rheumatology, Pays de Morlaix Hospital Centre, Morlaix, France
| | - Benjamin Dervieux
- Department of Rhuamtology, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Guillaume Direz
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Divi Cornec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Dewi Guellec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM Clinical Investigations Centre 1412, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Thierry Marhadour
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
- Centre Hospitalier Universitaire de Brest, Brest, INSERM Clinical Investigations Centre (CIC) 1412, France
| | - Alain Saraux
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
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Coskun Benlidayi I. Why is polymyalgia rheumatica a disease of older adults? Explanations through etiology and pathogenesis: a narrative review. Clin Rheumatol 2024; 43:851-861. [PMID: 37470883 DOI: 10.1007/s10067-023-06708-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/23/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023]
Abstract
Polymyalgia rheumatica is one of the most common inflammatory rheumatic conditions in older adults. The disease is characterized by pain and stiffness in the shoulder and pelvic girdle. Polymyalgia rheumatica is almost always observed in adults over the age of 50. The current article aimed to provide explanations for the age preference of polymyalgia rheumatica by reviewing the literature regarding disease etiology and pathogenesis. Potential factors related to the association between polymyalgia rheumatica and aging include immunosenescence/inflammaging, increased risk of infections by aging, endocrinosenescence, and age-related changes in gut microbiota. These factors and their potential contributions to immune-mediated inflammation will be discussed.
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Affiliation(s)
- Ilke Coskun Benlidayi
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cukurova University, Adana, Turkey.
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Schmidt WA. [Sarilumab for polymyalgia rheumatica]. Z Rheumatol 2024; 83:151-152. [PMID: 38240818 DOI: 10.1007/s00393-024-01474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 02/29/2024]
Affiliation(s)
- Wolfgang A Schmidt
- Abt. für Rheumatologie und Klinische Immunologie, Standort Berlin-Buch, Immanuel Krankenhaus Berlin, Lindenberger Weg 19, 13125, Berlin, Deutschland.
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Hofmann W, Kötter I, Winterhalter S, Krupp S. [Polymyalgia rheumatica-A challenge in geriatrics : Interdisciplinary presentation of diagnostics and treatment]. Z Rheumatol 2024; 83:112-121. [PMID: 38285216 DOI: 10.1007/s00393-024-01484-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Polymyalgia rheumatica is the second most frequent inflammatory rheumatic disease in people aged over 50 years, after rheumatoid arthritis. It is characterized by pain and morning stiffness in the region of the shoulders, hip girdle and neck. It can be associated with giant cell arteritis (CGA). Treatment with glucocorticoids is indispensable. The duration of treatment varies and often exceeds 1 year. The additive administration of methotrexate is an option for saving glucocorticoids. The biologicals tocilizumab or secukinumab are very promising alternatives. The course of treatment should be closely monitored for inflammation parameters, glucocorticoid side effects, pain, visual acuity, depression, activities of daily living and especially related to functions of the upper extremities. The geriatric assessment plays an important role in the management of this condition.
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Affiliation(s)
- W Hofmann
- , An den Uferwiesen 6, 17248, Rechlin/Müritz, Deutschland.
- ehem. Geriatrisches Zentrum, Neumünster und Bad Bramstedt, Deutschland.
| | - I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
- Sektion Rheumatologie und entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Winterhalter
- Klinik für Augenheilkunde, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
| | - S Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck - Geriatriezentrum, Lübeck, Deutschland
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Nageswaran P, Ahmed S, Tahir H. Review of phase 2/3 trials in polymyalgia rheumatica and giant cell arteritis. Expert Opin Emerg Drugs 2024; 29:5-17. [PMID: 38180809 DOI: 10.1080/14728214.2024.2303093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 01/07/2024]
Abstract
INTRODUCTION GCA (giant cell arteritis) and PMR (polymyalgia rheumatica) are two overlapping inflammatory rheumatic conditions that are seen exclusively in older adults, sharing some common features. GCA is a clinical syndrome characterized by inflammation of the medium and large arteries, with both cranial and extracranial symptoms. PMR is a clinical syndrome characterized by stiffness in the neck, shoulder, and pelvic girdle muscles. Both are associated with constitutional symptoms. AREAS COVERED In this review, we assess the established and upcoming treatments for GCA and PMR. We review the current treatment landscape, completed trials, and upcoming trials in these conditions, to identify new and promising therapies. EXPERT OPINION Early use of glucocorticoids (GC) remains integral to the immediate management of PMR and GCA but being aware of patient co-morbidities that may influence treatment toxicity is paramount. As such GC sparing agents are required in the treatment of PMR. Currently there are limited treatment options available for PMR and GCA, and significant unmet needs remain. Newer mechanisms of action, and hence therapeutic options being studied include CD4 T cell co-stimulation blockade, IL-17 inhibition, IL-12/23 inhibition, GM-CSF inhibition, IL-1β inhibition, TNF-α antagonist and Jak inhibition, among others, which will be discussed in this review.
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Affiliation(s)
| | - Saad Ahmed
- Department of Rheumatology, East Suffolk and North Essex Foundation Trust, Colchester, UK
| | - Hasan Tahir
- Department of Rheumatology, Royal Free London NHS Trust, London, UK
- Department of Medicine, University College London, London, UK
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Bond M, Dejaco C. Polymyalgia rheumatica: crafting the future of a simple (but not easy!) clinical syndrome. Ann Rheum Dis 2024; 83:271-273. [PMID: 38071513 DOI: 10.1136/ard-2023-225192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Milena Bond
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
| | - Christian Dejaco
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Teaching Hospital of the Paracelsius Medical University, Brunico, Italy
- Department of Rheumatology, Medical University of Graz, Graz, Austria
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Sattui SE, Xie F, Wan Z, Clinton C, Domsic RT, Curtis JR. Treatment of Polymyalgia Rheumatica by Rheumatology Providers: Analysis from the American College of Rheumatology RISE Registry. Arthritis Care Res (Hoboken) 2024; 76:259-264. [PMID: 37563714 DOI: 10.1002/acr.25216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE This study describes the demographics, comorbidities, and treatment patterns in a national cohort of patients with polymyalgia rheumatica (PMR) who received care from rheumatology providers. METHODS Patients with PMR were identified in the American College of Rheumatology Rheumatology Informatics System for Effectiveness registry from 2016 to 2022. Use of glucocorticoids and immunomodulatory antirheumatic medications used as steroid-sparing agents were examined overall and in a subgroup of patients new to rheumatology practices, the majority with presumed new-onset PMR. In these new patients, multivariate logistic regressions were performed to identify factors associated with persistent glucocorticoid and steroid-sparing agent use at 12 to 24 months. RESULTS A total of 26,102 patients with PMR were identified, of which 16,703 new patients were included in the main analysis. Patients were predominantly female (55.8%) and White (46.7%), with a mean age of 72.0 years. Hypertension (81.2%), congestive heart failure (52.4%), hyperlipidemia (41.3%), and ischemic heart disease (36.0%) were the most prevalent comorbidities. At baseline, 92.3% of patients were on glucocorticoids, and only 13.1% were on a steroid-sparing agent. At 12 to 24 months, most patients remained on glucocorticoids (63.8%). Although there was an increase in use through follow-up, antirheumatic medications were prescribed only to a minority (39.0%) of patients with PMR. CONCLUSION In this large US-based study of patients with PMR receiving rheumatology care, only a minority of patients were prescribed steroid-sparing agents during the first 24 months of follow-up; most patients remained on glucocorticoids past one year. Further identification of patients who would benefit from steroid-sparing agents and the timing of steroid-sparing agent initiation is needed.
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Affiliation(s)
| | - Fenglong Xie
- University of Alabama at Birmingham and Foundation for Advancing Science, Technology, Education and Research, Birmingham, Alabama
| | - Zihan Wan
- Duke Cancer Institute-Biostatistics Shared Resource, Duke University Medical Center, Durhame, North Carolina
| | | | | | - Jeffrey R Curtis
- University of Alabama at Birmingham and Foundation for Advancing Science, Technology, Education and Research, Birmingham, Alabama
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Barde F, Ascione S, Pacoureau L, Macdonald C, Salliot C, Boutron-Ruault MC, Seror R, Nguyen Y. Accuracy of self-reported diagnoses of polymyalgia rheumatica and giant cell arteritis in the French prospective E3N- EPIC cohort: A validation study. Semin Arthritis Rheum 2024; 64:152298. [PMID: 38000317 DOI: 10.1016/j.semarthrit.2023.152298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To assess the accuracy of self-reported giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) diagnoses in a large French population-based prospective cohort, and to devise algorithms to improve their accuracy. METHODS The E3N-EPIC cohort study (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) includes 98,995 French women born between 1925 and 1950, recruited in 1990 to study risk factors of cancer and chronic diseases. They completed biennially mailed questionnaires to update their health-related information and lifestyle characteristics. In three questionnaires, women could self-report a diagnosis of GCA/PMR. Those women were additionally sent a specific questionnaire, designed to ascertain self-reported diagnoses of GCA/PMR. Four algorithms were then devised to improve their identification. Accuracies of self-reported diagnoses and of each algorithm were calculated by comparing the diagnoses with a blinded medical chart review. RESULTS Among 98,995 participants, 1,392 women self-reported GCA/PMR. 830 women sent back the specific questionnaire, and 202 women provided medical charts. After independent review of the 202 medical charts, 87.6 % of the self-reported diagnoses of GCA/PMR were accurate. Using additional data from a specific questionnaire (diagnosis confirmation by a physician, and self-report of >3-month of glucocorticoids), and from a reimbursement database (at least two deliveries of glucocorticoids in less than 3 consecutive months) improved their accuracy (91.8 % to 92.8 %). CONCLUSION The accuracy of self-reported diagnosis of GCA/PMR was high in the E3N-cohort but using additional data as a specific GCA/PMR questionnaire and/or corticosteroid reimbursement database further improved this accuracy. With nearly 600 detected cases of GCA/PMR, we will be able to investigate risk factors for GCA/PMR in women.
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Affiliation(s)
- François Barde
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Sophia Ascione
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Lucas Pacoureau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Conor Macdonald
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Carine Salliot
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Raphaèle Seror
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France.
| | - Yann Nguyen
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France; Department of Internal Medicine, AP-HP. Nord, Hôpital Beaujon, Université de Paris, Clichy, France
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13
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Zhao SS, Rajeswaran T, Mackie SL, Yarmolinsky J. Genetically proxied IL-1 receptor antagonism and risk of polymyalgia rheumatica. Rheumatology (Oxford) 2024; 63:e43-e44. [PMID: 37594741 PMCID: PMC10836967 DOI: 10.1093/rheumatology/kead423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Science, School of Biological Sciences, Faculty of Biological Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Thurkka Rajeswaran
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- National Institute for Health Research Leeds Biomedical Research Centre, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - James Yarmolinsky
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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De Miguel E, Macchioni P, Conticini E, Campochiaro C, Karalilova R, Monti S, Ponte C, Klinowski G, Monjo-Henry I, Falsetti P, Batalov Z, Tomelleri A, Hocevar A. Prevalence and characteristics of subclinical giant cell arteritis in polymyalgia rheumatica. Rheumatology (Oxford) 2024; 63:158-164. [PMID: 37129541 DOI: 10.1093/rheumatology/kead189] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE The main objective of this study was to analyse the prevalence and characteristics of subclinical GCA in patients with PMR. METHODS This was a cross-sectional multicentre international study of consecutive patients with newly diagnosed PMR without symptoms or signs suggestive of GCA. All patients underwent US of the temporal superficial, common carotid, subclavian and axillary arteries. Patients with halo signs in at least one examined artery were considered to have subclinical GCA. The clinical, demographic and laboratory characteristics of the PMR group without subclinical vasculitis were compared with subclinical GCA, and the pattern of vessel involvement was compared with that of a classical single-centre GCA cohort. RESULTS We included 346 PMR patients, 267 (77.2%) without subclinical GCA and 79 (22.8%) with subclinical GCA. The PMR patients with subclinical GCA were significantly older, had a longer duration of morning stiffness and more frequently reported hip pain than PMR without subclinical GCA. PMR with subclinical GCA showed a predominant extracranial large vessel pattern of vasculitic involvement compared with classical GCA, where the cranial phenotype predominated. The patients with PMR in the classical GCA group showed a pattern of vessel involvement similar to classical GCA without PMR but different from PMR with subclinical involvement. CONCLUSION More than a fifth of the pure PMR patients had US findings consistent with subclinical GCA. This specific subset of patients showed a predilection for extracranial artery involvement. The optimal screening strategy to assess the presence of vasculitis in PMR remains to be determined.
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Affiliation(s)
- Eugenio De Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Edoardo Conticini
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology Department, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Rositsa Karalilova
- Rheumatology Department, Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte EPE, Lisboa, Portugal
| | - Giulia Klinowski
- Department of Rheumatology, IRCCS-S.Maria Nuova, Reggio Emilia, Italy
| | - Irene Monjo-Henry
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Paolo Falsetti
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Zguro Batalov
- Rheumatology Department, Medical University of Plovdiv, University Hospital Kaspela, Plovdiv, Bulgaria
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology Department, Allergy and Rare Diseases (UnIRAR), San Raffaele Scientific Institute, Milan, Italy
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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15
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Vinicki JP, Gut O, Maliandi MDR, Velasco Zamora JL, Linarez M, Cusa MA, Got J, Spinetto MA, Estevez AJ, Brigante A, Curti AC, Costi AC, Cavallasca J. Risk Factors for Relapse and/or Prolonged Glucocorticoid Therapy in Polymyalgia Rheumatica: Multicenter Study in 185 Patients. J Clin Rheumatol 2024; 30:e34-e38. [PMID: 37185203 DOI: 10.1097/rhu.0000000000001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND In polymyalgia rheumatica (PMR) relapses and long-term GC dependency are common. We assessed risk factors for higher relapse rate and/or prolonged glucocorticoid therapy in PMR patients. METHODS A multicenter and observational study (chart review) of PMR patients seen between 2006 and 2021 who had at least a 3-month follow-up period after starting GCs was performed. Results were expressed as median and interquartile range 25th-75th or mean ± standard deviation for numerical variables and percentage for categorical ones. Relapse versus nonrelapse groups were compared using Cox proportional analysis. Hazards ratios (HRs) with 95% confidence intervals (CIs) are reported. In all cases, a p value <0.05 was considered to indicate statistical significance. RESULTS We included 185 patients (69.1% female). The median follow-up time was 17.1 months (interquartile range, 6.8-34.7). Incidence of relapses was 1.2 per 100 persons/month. In univariate analysis, PMR patients with a previous history of dyslipidemia had a lower risk of relapse (HR, 0.55; 95% CI, 0.33-0.94; p = 0.03); high-dose GC (HR, 2.35; 95% CI, 1.42-3.87; p = 0.001) and faster GC dose reduction had higher risk of relapse (HR, 3.04; 95% CI, 1.77-5.21; p = 0.001). In multivariate analysis, a previous history of dyslipidemia had a lower risk of relapse (HR, 0.54; 95% CI, 0.32-0.92; p = 0.023), and high dose of GC (HR, 2.46; 95% CI, 1.49-4.08; p = 0.001) remained the only risk factors for relapse. CONCLUSIONS Lower doses of corticosteroids and a slow rate of reduction are critical to avoid relapse in PMR. Risk factors for higher relapse rate rely on therapy more than clinical characteristics of the patients at the time of diagnosis of PMR.
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Affiliation(s)
| | | | | | | | | | | | - Julio Got
- Unidad de Reumatología, Instituto Médico Humanitas, Chaco
| | | | | | | | | | | | - Javier Cavallasca
- Sección Reumatología, Hospital José Bernardo Iturraspe, Santa Fe, Argentina
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16
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Xiao X, Li S. Genetically determined iron status was associated with polymyalgia rheumatica but not with giant cell arteritis: A Mendelian randomization analysis. Int J Rheum Dis 2024; 27:e14841. [PMID: 37477187 DOI: 10.1111/1756-185x.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Xun Xiao
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shizhen Li
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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17
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González García A, Del Arco C, Lucas Fernández D, Frías-Vargas M, Guillán M, Méndez-Bailón M, Ruiz Grinspan M, Aguado-Castaño AC, Fraile Maya J, Latorre González G, Castañeda S. Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region. Rev Clin Esp 2024; 224:48-56. [PMID: 38142973 DOI: 10.1016/j.rceng.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications. With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies. After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies.
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Affiliation(s)
- A González García
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - C Del Arco
- Servicio de Urgencias, Hospital Universitario de la Princesa, Instituto de Investigación la Princesa, Madrid, Spain
| | | | - M Frías-Vargas
- Centro de Salud Comillas, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - M Guillán
- Servicio de Neurología, Unidad de Ictus, Hospital Universitario Rey Juan Carlos, Madrid, Spain
| | - M Méndez-Bailón
- Servicio de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain
| | - M Ruiz Grinspan
- Servicio de Urgencias, Hospital Universitario del Henares, Coslada, Spain
| | | | - J Fraile Maya
- Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain
| | - G Latorre González
- Servicio de Neurología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - S Castañeda
- Servicio de Reumatología, Hospital de La Princesa, IIS-Princesa, Madrid, Spain; Cátedra UAM-Roche, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
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18
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Salvarani C, Padoan R, Iorio L, Tomelleri A, Terrier B, Muratore F, Dasgupta B. Subclinical giant cell arteritis in polymyalgia rheumatica: Concurrent conditions or a common spectrum of inflammatory diseases? Autoimmun Rev 2024; 23:103415. [PMID: 37625672 DOI: 10.1016/j.autrev.2023.103415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/20/2023] [Indexed: 08/27/2023]
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are common conditions in older adults. Their clinical connection has been recognized over time, with many patients experiencing both conditions separately, simultaneously or in temporal sequence to each other. Early GCA detection is essential to prevent vascular damage, but identifying subclinical GCA in PMR patients remains a challenge and routine screening is not standard practice. Subclinical GCA prevalence in newly diagnosed PMR patients ranges from 23 to 29%, depending on the screening method. Vessel wall imaging and temporal artery biopsy can detect subclinical GCA. Epidemiology and trigger factors show similarities between the two conditions, but PMR is more common than GCA. Genetic and pathogenesis studies reveal shared inflammatory mechanisms involving dendritic cells, pro-inflammatory macrophages, and an IL-6 signature. However, the inflammatory infiltrates differ, with extensive T cell infiltrates seen in GCA while PMR shows an incomplete profile of T cell and macrophage-derived cytokines. Glucocorticoid treatment is effective for both conditions, but the steroid requirements vary. PMR overall mortality might be similar to the general population, while GCA patients with aortic inflammatory aneurysms face increased mortality risk. The GCA-PMR association warrants further research. Considering their kinship, recently the term GCA-PMR Spectrum Disease (GPSD) has been proposed.
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Affiliation(s)
- Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy.
| | - Luca Iorio
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Francesco Muratore
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena and Reggio Emilia, Reggio Emilia, Italy
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19
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Tanaka Y, Tanaka S, Takahashi T, Kato N. Clinical features of polymyalgia rheumatica patients in Japan: Analysis of real-world data from 2015 to 2020. Mod Rheumatol 2023; 34:201-207. [PMID: 36881671 DOI: 10.1093/mr/road026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES To assess clinical features in patients with polymyalgia rheumatica (PMR) in Japan by the International Classification of Disease (ICD)-10 code assignment. METHODS Demographics, treatment patterns, and concomitant diseases (identified using ICD-10 code only) in patients who were assigned the PMR ICD-10 code M35.3 at least once between 1 January 2015 and 31 December 2020 were aggregated from a nationwide medical information database owned by the Health, Clinic, and Education Information Evaluation Institute. RESULTS The cumulative number of patients with PMR was 6325 (mean [standard deviation] age, 74.3 [11.4] years; male:female, 1:1.3). Most patients were >50 years (96.5%) with >33% between 70 and 79 years. Glucocorticoids were prescribed in ∼54% of patients within 30 days of PMR code assignment. All other drug types were prescribed in <5% of patients. Hypertension, diabetes mellitus, rheumatoid arthritis, and osteoporosis were noted in >25% and giant cell arteritis in 1% of patients. During the study period, 4075 patients were newly assigned the PMR code and 62% were prescribed glucocorticoids within 30 days. CONCLUSIONS This is the first retrospective real-world data analysis describing the clinical features of PMR in a large patient population from Japan. Further studies of prevalence, incidence, and clinical features are warranted in patients with PMR.
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Affiliation(s)
- Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinichi Tanaka
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | | | - Naoto Kato
- Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan
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20
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Manzo C. Early referral of patients with suspected polymyalgia rheumatica: An active involvement of the out-of-hospital public rheumatologist is needed. Semin Arthritis Rheum 2023; 63:152309. [PMID: 37951127 DOI: 10.1016/j.semarthrit.2023.152309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Ciro Manzo
- Department of Internal and Geriatric Medicine, Rheumatologic Outpatient Clinic, Health District No. 59, Azienda Sanitaria Locale Naples sud, viale dei Pini 1, Sant'Agnello, Naples 80065, Italy.
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21
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Harris GK, Leung JL, Buchanan RRC. Exploring the patient experience in polymyalgia rheumatica. Clin Rheumatol 2023; 42:3421-3422. [PMID: 37861872 DOI: 10.1007/s10067-023-06794-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
Despite being the most common inflammatory rheumatic disease in the elderly (Partington et al., Ann Rheum Dis 77(12):1750-175, 2018), few studies to date have examined the patient experience of polymyalgia rheumatica (PMR). Our study explored patient perspectives in PMR by means of a survey and semi-structured group interviews. The results from this study highlight key aspects of the patient experience in PMR, including delays to diagnosis, complex attitudes toward glucocorticoid therapy, and a desire for alternate treatment strategies. Future trials should look to include physical function as a measured outcome. Finally, our results call attention to the chronicity of PMR symptoms, challenging the paradigm of PMR as a self-limiting condition.
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Affiliation(s)
- Georgia K Harris
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia.
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
| | - Jessica L Leung
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
| | - Russell R C Buchanan
- Department of Rheumatology, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia
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22
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Liew DF, Owen CE. Designing studies in newly diagnosed versus established polymyalgia rheumatica. Lancet Rheumatol 2023; 5:e701-e703. [PMID: 38251558 DOI: 10.1016/s2665-9913(23)00294-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024]
Affiliation(s)
- David Fl Liew
- Department of Rheumatology, Austin Health, Melbourne, VIC 3081, Australia; Department of Clinical Pharmacology and Therapeutics, Austin Health, Melbourne, VIC 3081, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Claire E Owen
- Department of Rheumatology, Austin Health, Melbourne, VIC 3081, Australia; Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
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23
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Paltta J, Suuronen S, Pirilä L, Palomäki A. Differential diagnostics of polymyalgia rheumatica in a university hospital in Finland. Scand J Rheumatol 2023; 52:689-695. [PMID: 37335188 DOI: 10.1080/03009742.2023.2215044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES Diagnosing polymyalgia rheumatica (PMR) can be difficult as many conditions present with similar symptoms and findings. This study aimed to analyse how often the diagnosis of PMR changes during follow-up in a university hospital setting and to determine the most common clinical conditions initially misdiagnosed as PMR. METHOD All patients with a new primary diagnosis of PMR on at least one visit during the years 2016-2019 were identified from the hospital discharge register of Turku University Hospital, Finland. A diagnosis of PMR was confirmed if the patient met at least one of the five classification criteria, complete clinical follow-up (median 34 months) was compatible with PMR, and no other diagnosis better explained their condition. RESULTS Of the patients initially diagnosed with PMR, 65.5% were considered to have PMR after further evaluation and clinical follow-up. The most common conditions initially diagnosed as PMR were inflammatory arthritides (34.9%), degenerative or stress-related musculoskeletal disorders (13.2%), infection (9.3%), malignancy (9.3%), giant cell vasculitis (6.2%) and other vasculitis (6.2%), and a wide range of other less common diseases. The diagnosis of PMR remained in 81.3% of patients who fulfilled the 2012 American College of Rheumatology/European League Against Rheumatism PMR classification criteria and in 45.5% of patients who did not. CONCLUSIONS Diagnosing PMR is challenging, even in a university hospital. One-third of the initial diagnoses of PMR changed during further evaluation and follow-up. There is a substantial risk of misdiagnosis, especially in patients with atypical presentation, and the differential diagnoses of PMR must be considered carefully.
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Affiliation(s)
- J Paltta
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - S Suuronen
- Department of Medicine, University of Turku, Turku, Finland
| | - L Pirilä
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - A Palomäki
- Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
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25
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Perricone C, Cafaro G, Fiumicelli E, Bursi R, Bogdanos D, Riccucci I, Gerli R, Bartoloni E. Predictors of complete 24-month remission and flare in patients with polymyalgia rheumatica. Clin Exp Med 2023; 23:3391-3397. [PMID: 36566303 DOI: 10.1007/s10238-022-00976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Abstract
To date, few papers investigated the predictive factors of sustained 24-month remission and of flare in patients with polymyalgia rheumatica (PMR). We retrospectively evaluated clinical charts from PMR patients. Patients were evaluated at baseline, at 1 month, 3 months and subsequently at 6, 12 and 24 months. We analyzed the differences between patients who achieved remission within 6 months of diagnosis, those who achieved remission at 24 months, and patients who did not. Among 137 patients, 57 (41.6%) achieved remission at 6 months and complete remission at 24 months was achieved by 104 patients (75.9%). The erythrocyte sedimentation rate at baseline was higher in patients who did not achieve remission than in patients who achieved it (p = 0.012). Female patients were less likely to achieve complete remission (45/68, 66.2% vs. 59/69, 85.5%, p = 0.01) compared to males. Fifty-four patients (39.4%) experienced at least one flare. Patients who did not achieve sustained complete remission suffered a flare more often (22/39 vs. 32/98, p = 0.01) and earlier than patients who did (10.33 ± 7.89 months vs. 13.64 ± 6.97 months, p = 0.011). Multivariate analysis confirmed that female sex (RR = 3.2, 95% CI 1.3-7.9) and higher baseline prednisone dosage (RR = 1.1, 95% CI 1.007-1.109) were negative independent predictors of complete remission at 24 months. A significant percentage of patients with PMR requires prolonged steroid treatment and may experience flares at 24 months of follow-up. Female sex and higher baseline prednisone dosage are negative independent predictors of complete remission at 24 months.
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Affiliation(s)
- Carlo Perricone
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy.
| | - Giacomo Cafaro
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Fiumicelli
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Bursi
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Dimitrios Bogdanos
- Internal Medicine and Autoimmune Diseases, Department Internal Medicine, University of Thessaly, Larissa, Greece
| | - Ilenia Riccucci
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Roberto Gerli
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
| | - Elena Bartoloni
- Rheumatology, Department of Medicine and Surgery, University of Perugia, Piazzale Giorgio Menghini, 1, 06129, Perugia, Italy
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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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Ishiguro K, Yamashita H, Shimizu Y, Kaneko H. Biomarkers as predicting factors for relapse in polymyalgia rheumatica: the importance of alkaline phosphatase. Rheumatology (Oxford) 2023; 62:e288-e290. [PMID: 37014366 DOI: 10.1093/rheumatology/kead137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 04/05/2023] Open
Affiliation(s)
- Kenji Ishiguro
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
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Leung JL, Twohig H, Muller S, Maxwell L, Mackie SL, Neill LM, Owen CE. Test-retest reliability of pain VAS/NRS, stiffness VAS/NRS, HAQ-DI and mHAQ in polymyalgia rheumatica: An OMERACT study. Semin Arthritis Rheum 2023; 62:152239. [PMID: 37429139 DOI: 10.1016/j.semarthrit.2023.152239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To examine the test-retest reliability of four measurement instruments in polymyalgia rheumatica (PMR): pain severity visual analogue scale (VAS) / numerical rating score (NRS), stiffness severity VAS/NRS, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the modified Health Assessment Questionnaire (mHAQ). METHOD Two prospectively collected datasets were used. All participants had a diagnosis of PMR and only those with stable disease were included in analyses. Measurement instruments were administered twice, with a testing interval of two to six weeks. The intra-class correlation coefficient (ICC) was calculated using a two-way mixed effects model looking for absolute agreement. ICC values of 0.8-0.9 were deemed representative of good test-retest reliability, whilst values >0.9 were representative of excellent test-retest reliability. RESULTS From the first dataset, 38 participants were analysed. The ICC between baseline and 2 weeks for pain VAS, stiffness VAS, HAQ-DI and mHAQ were 0.84, 0.82, 0.92 and 0.92 respectively. From the second dataset, 58 participants were included in the analysis for pain NRS, 59 for stiffness NRS and 78 for mHAQ. The ICC between baseline and follow-up for pain NRS, stiffness NRS and mHAQ were 0.80, 0.83 and 0.87 respectively. CONCLUSION Pain severity VAS/NRS, stiffness severity VAS/NRS, HAQ-DI and mHAQ all demonstrate good to excellent test-retest reliability in a PMR patient population.
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Affiliation(s)
- Jessica L Leung
- Austin Health, 145 Studley Road, Heidelberg, Victoria, Australia; The University of Melbourne, Swanston Street, Parkville, Victoria, Australia.
| | - Helen Twohig
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Sara Muller
- School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom.
| | - Lara Maxwell
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada.
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom; NIHR Leeds Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, United Kingdom.
| | - Lorna M Neill
- OMERACT Patient Research Partner, PMR-GCA Scotland Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Claire E Owen
- Austin Health, 145 Studley Road, Heidelberg, Victoria, Australia; The University of Melbourne, Swanston Street, Parkville, Victoria, Australia.
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Kara M, Alp G, Koç AM. Diagnostic difficulties in polymyalgia rheumatica cases with normal erythrocyte sedimentation rate and C-reactive protein values. Medicine (Baltimore) 2023; 102:e35385. [PMID: 37773830 PMCID: PMC10545350 DOI: 10.1097/md.0000000000035385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/04/2023] [Indexed: 10/01/2023] Open
Abstract
Polymyalgia Rheumatica (PMR) is an inflammatory disease which does not have specific diagnostic tests or pathological symptoms and is identified based on clinical characteristics. Among acute phase reactants (APR), the erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are laboratory findings used in diagnosis and follow-up. In this study, it was aimed to determine the incidence of normal ESH and CRP in patients diagnosed with PMR and identify the distinguishing characteristics of these patients. PMR patients who were clinically diagnosed at a single center were reviewed. After the presence of bursitis was demonstrated with ultrasonography in patients with normal ESR and CRP rates, they were accepted to have PMR. Among all 54 patients (63% female), ESR and CRP values were normal in 8 patients (14%), and serum amyloid A (SAA) was determined to be elevated in all these patients. In the comparisons of the groups with normal and high levels of ESR and CRP, it was found that the group with normal ESR and CRP values had a younger age of diagnosis (P = .027), a longer symptom duration (P < .001), and a lower comorbidity rate (P = .010). PMR patients can have normal ESR and CRP values at the time of their diagnosis. While bursitis can be demonstrated with ultrasonography in patients who are clinically evaluated to have PMR, APRs such as SAA other than ESR and CRP can also be used.
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Affiliation(s)
- Mete Kara
- University of Health Sciences Izmir Bozyaka Research and Training Hospital, Rheumatology Department, Izmir, Turkey
| | - Gülay Alp
- Izmir Katip Celebi University Izmir Atatürk Research and Training Hospital, Rheumatology Department, Izmir, Turkey
| | - Ali Murat Koç
- Izmir Katip Celebi University Izmir Atatürk Research and Training Hospital, Department of Radiology, Izmir, Turkey
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30
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Mukhtyar CB. Reply: Who can get it right for polymyalgia rheumatica? Clin Exp Rheumatol 2023; 41 Suppl 135:23. [PMID: 36719753 DOI: 10.55563/clinexprheumatol/1ca61t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK.
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31
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Manzo C, Natale M, Nune A, Castagna A. The management of patients with polymyalgia rheumatica: limitations to get it right. Clin Exp Rheumatol 2023; 41 Suppl 135:22. [PMID: 36719744 DOI: 10.55563/clinexprheumatol/dxmvl1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Ciro Manzo
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3, Health District no 59, Sant'Agnello, Italy.
| | - Maria Natale
- Internal and Geriatric Medicine Department, Azienda Sanitaria Locale Napoli 3, Health District no 59, Sant'Agnello, Italy
| | - Arvind Nune
- Department of Rheumatology, Southport and Ormskirk Hospital NHS Trust, Southporth, UK
| | - Alberto Castagna
- Primary Care Department, Azienda Sanitaria Provinciale Catanzaro, Soverato, Italy
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32
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Moreel L, Doumen M, Betrains A, Blockmans D, Verschueren P, Vanderschueren S. The future of polymyalgia rheumatica research: What can we learn from rheumatoid arthritis? Joint Bone Spine 2023; 90:105529. [PMID: 36690063 DOI: 10.1016/j.jbspin.2023.105529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Lien Moreel
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.
| | - Michaël Doumen
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Daniel Blockmans
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Utrecht, The Netherlands
| | - Patrick Verschueren
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, 49, Herestraat, 3000 Leuven, Belgium; Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), Utrecht, The Netherlands
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33
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Gomes de Pinho Q, Daumas A, Benyamine A, Bertolino J, Ebbo M, Schleinitz N, Harlé JR, Jarrot PA, Kaplanski G, Berbis J, Boucekine M, Rossi P, Granel B. Predictors of Relapses or Recurrences in Patients With Giant Cell Arteritis: A Medical Records Review Study. J Clin Rheumatol 2023; 29:e25-e31. [PMID: 36727749 DOI: 10.1097/rhu.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Giant cell arteritis (GCA) is the most common systemic vasculitis in individuals aged ≥50 years. Its course is marked by a high relapse rate requiring long-term glucocorticoid use with its inherent adverse effects. We aimed to identify factors associated with relapses or recurrences in GCA at diagnosis. METHODS We reviewed the medical records of consecutive patients with GCA diagnosed between 2009 and 2019 and followed for at least 12 months. We recorded their characteristics at onset and during follow-up. Factors associated with relapses or recurrences were identified using multivariable analysis. RESULTS We included 153 patients, among whom 68% were female with a median age of 73 (47-98) years and a median follow-up of 32 (12-142) months. Seventy-four patients (48.4%) had at least 1 relapse or recurrence. Headache and polymyalgia rheumatica were the most frequent manifestations of relapses. The first relapse occurred at a median time of 13 months after the diagnosis, with a median dose of 5.5 (0-25) mg/d of glucocorticoids.In multivariable analysis, patients with relapses or recurrences had a higher frequency of cough and scalp tenderness at diagnosis (20.3% vs 5.1%; odds ratio [OR], 4.73; 95% confidence interval [CI], 1.25-17.94; p = 0.022; and 41.9% vs 29.1%; OR, 2.4; 95% CI, 1.07-5.39; p = 0.034, respectively). Patients with diabetes mellitus at diagnosis had fewer relapses or recurrences during follow-up (5.4% vs 19%; OR, 0.24; 95% CI, 0.07-0.83; p = 0.024). CONCLUSIONS Cough and scalp tenderness at diagnosis were associated with relapses or recurrences, whereas patients with diabetes experienced fewer relapses or recurrences.
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Affiliation(s)
- Quentin Gomes de Pinho
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Aurélie Daumas
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne, Gériatrie et Thérapeutique
| | - Audrey Benyamine
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Julien Bertolino
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Mikaël Ebbo
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Nicolas Schleinitz
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Jean-Robert Harlé
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne
| | - Pierre André Jarrot
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Gilles Kaplanski
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Conception, Service de Médecine Interne et Immunologie Clinique
| | - Julie Berbis
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Mohamed Boucekine
- Faculté de Médecine de la Timone, Laboratoire de Santé Publique, EA 3279, Centre d'Étude et de Recherche sur les Service de Santé et la Qualité de Vie, Aix-Marseille Université, Marseille, France
| | - Pascal Rossi
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
| | - Brigitte Granel
- From the Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Service de Médecine Interne
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Arends S, van der Geest KS, Sandovici M. Assessment of treatment efficacy in polymyalgia rheumatica. Lancet Rheumatol 2023; 5:e171-e173. [PMID: 38251513 DOI: 10.1016/s2665-9913(23)00056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, Netherlands.
| | - Kornelis Sm van der Geest
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, Netherlands
| | - Maria Sandovici
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9700 RB, Groningen, Netherlands
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35
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Smith LM, Alvarado LA, Dihowm F. The incidence and characteristics of giant cell arteritis in Hispanics and the associated outcomes of ischemic ocular events and stroke. J Investig Med 2023; 71:411-418. [PMID: 36710498 DOI: 10.1177/10815589231152821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Giant cell arteritis (GCA) is a large vessel vasculitis whereby up to half of all patients show ocular involvement, highlighting the importance of treating GCA before it leads to irreversible blindness. Most of the research published for GCA and associated adverse ocular events are based on majority Caucasian populations establishing the current belief that Hispanics have a much lower incident of GCA. We sought to investigate the incidence of GCA in Hispanics and characterize associated ocular events, stroke rates, and comorbid diseases. We conducted a retrospective cohort study of GCA-coded medical records in self-identified Hispanics assessed at the University Medical Center Hospital in El Paso, Texas. From 2000 to 2019, there were 68 new cases of GCA in the Hispanics which represents an average incidence of 0.062% with a 95% confidence interval of [0.05, 0.09] of Hispanics over the age of 50 admitted to University Medical Center hospital. Of the subjects diagnosed with GCA, the majority had ocular involvement such as blurry vision (47.06%), ocular pain (26.47%), and blindness (14.71%). We did not observe a history of stroke had a statistically significant difference associated with GCA with ophthalmic disease compared to GCA without ophthalmic disease. Polymyalgia rheumatica (PMR) was identified in only 2.94% of the Hispanic subjects with GCA. Major conclusions in our study advocate Hispanics with GCA are prevalent and unique in its associations with other comorbid diseases. Unlike non-Hispanic White populations, Hispanic subjects with GCA do not show an association with PMR nor an increased association with stroke.
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Affiliation(s)
- Lisa M Smith
- Paul L. Foster School of Medicine, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Luis A Alvarado
- Biostatistics and Epidemiology and Consulting Lab, Office of Research, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
| | - Fatma Dihowm
- Division of General Medicine, Department of Internal Medicine, Texas Tech University Health Science Center El Paso, El Paso, TX, USA
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36
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Katayama K, Ishizuka K, Tawara J, Kaji Y, Komuta M, Hayashi Y, Gomi H, Akahane M, Ohira Y. Temporal Arteritis Caused by Tertiary Syphilis. Intern Med 2023; 62:1095-1097. [PMID: 36047113 PMCID: PMC10125830 DOI: 10.2169/internalmedicine.9779-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old man arrived at our hospital with bilateral shoulder pain persisting for several months and headache for 1 month. Giant cell arteritis with polymyalgia rheumatica was suspected. However, considering his medical history of testing positive for syphilis, we submitted a sample for a syphilis serology test, which yielded positive results. The Treponema pallidum hemagglutination assay of cerebrospinal fluid was positive, and a temporal artery biopsy revealed vasculitis, confirming the diagnosis of tertiary syphilis. He was successfully treated for two weeks with penicillin G infusions. Symptoms reminiscent of giant cell arteritis and polymyalgia rheumatica may reveal syphilis, which is called the "great imitator."
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Affiliation(s)
- Kohta Katayama
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Kosuke Ishizuka
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Junsuke Tawara
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Yuki Kaji
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Mina Komuta
- Department of Pathology, International University of Health and Welfare, Japan
| | - Yuichiro Hayashi
- Department of Pathology, International University of Health and Welfare, Japan
| | - Harumi Gomi
- Office of Medical Education and Center for Infectious Diseases, International University of Health and Welfare, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
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Bolhuis TE, Marsman DE, den Broeder AA, den Broeder N, van der Maas A. 1-year results of treatment with rituximab in polymyalgia rheumatica: an extension study of a randomised double-blind placebo-controlled trial. Lancet Rheumatol 2023; 5:e208-e214. [PMID: 38251523 DOI: 10.1016/s2665-9913(23)00032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Rituximab was effective for patients with polymyalgia rheumatica in the 21-week BRIDGE-PMR randomised controlled trial. Here, we aimed to assess rates of glucocorticoid-free remission up to 1 year after infusion in an extension of this trial. METHODS BRIDGE-PMR was a randomised controlled proof-of-concept trial that enrolled participants with polymyalgia rheumatica according to 2012 European League Against Rheumatism-American College of Rheumatology classification criteria at the Sint Maartenskliniek, Nijmegen, Netherlands. Patients were randomly allocated in a 1:1 ratio to receive one intravenous dose of 1000 mg rituximab or placebo, with identical pre-medication and accelerated glucocorticoid tapering over 17 weeks. After the 21-week study, patients were followed in a double-blind extension until 1 year after infusion during which standard-of-care treatment was provided. The primary outcome after 52 weeks was between-group difference in glucocorticoid-free remission (ie, polymyalgia rheumatica activity score [PMR-AS] <10), assessed in all randomly allocated participants, with data imputed using a predictive mean matching model (provided data were missing at random). A sensitivity analysis restricted to patients with complete data (complete case analysis) was also done. This trial is registered with EudraCT (2018-002641-11) and the Dutch trial database (NL7414). FINDINGS Between Dec 18, 2019 and June 8, 2021, 47 patients enrolled in the BRIDGE-PMR were followed up in this extension study (23 [11 women and 12 men] allocated rituximab and 24 [13 women and 11 men] allocated placebo), of who 38 had recently diagnosed polymyalgia rheumatica and nine had relapsing polymyalgia rheumatica. Mean (SD) age was 64 (10) years in the rituximab group and 66 (9) years in the placebo group. All participants were White. Missing data were imputed for six participants (four rituximab, two placebo); because the data were probably missing at random, a complete case analysis was added as sensitivity analyses. In the imputed analysis, the between-group absolute difference reached statistical significance (12 [52%] of 23 in the rituximab group in glucocorticoid-free remission vs five [21%] of 24 participants in the placebo group; absolute difference 31% [95% CI 5 to 57], RR 2·5 [1·0 to 6·0]; p=0·04). In the complete case analysis, nine (47%) of 19 patients in the rituximab group were in glucocorticoid-free remission 1 year after infusion compared with five (23%) of 22 in the placebo group (absolute difference 25% [95% CI -4 to 53], relative risk (RR) 2·1 [95% CI 0·8 to 5·2]; p=0·12). Eight (33%) patients in the placebo group and six (26%) in the rituximab group had adverse events. INTERPRETATION After a single dose of rituximab (1000 mg), the proportion of patients with polymyalgia rheumatica in glucocorticoid-free remission remained stable at 1 year after infusion, and a glucocorticoid sparing effect was evident. A larger trial including possibility for retreatment is warranted to confirm these results. FUNDING Sint Maartenskliniek.
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Affiliation(s)
- Thomas E Bolhuis
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Diane E Marsman
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nathan den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Aatke van der Maas
- Department of Rheumatology, Sint Maartenskliniek, Ubbergen, Netherlands.
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González-Gay MA, Vicente-Rabaneda EF, Heras-Recuero E, Castañeda S. Polymyalgia rheumatica: when should we suspect an underlying large vessel vasculitis? Clin Exp Rheumatol 2023; 41:774-776. [PMID: 36995322 DOI: 10.55563/clinexprheumatol/3bozph] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Miguel Angel González-Gay
- RheumatologyDivision, IIS-Fundación Jiménez Díaz, Madrid; University of Cantabria, Santander, Spain; and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Esther F Vicente-Rabaneda
- RheumatologyDivision, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | - Santos Castañeda
- RheumatologyDivision, Hospital de La Princesa, IIS-Princesa, Universidad Autónoma de Madrid (UAM), Madrid, and Catedra UAM-Roche, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
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Ohta R, Sano C. Differentiating between Seronegative Elderly-Onset Rheumatoid Arthritis and Polymyalgia Rheumatica: A Qualitative Synthesis of Narrative Reviews. Int J Environ Res Public Health 2023; 20:ijerph20031789. [PMID: 36767155 PMCID: PMC9914621 DOI: 10.3390/ijerph20031789] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 05/13/2023]
Abstract
Elderly-onset rheumatoid arthritis (EORA) is prevalent among older patients, and its incidence is increasing due to aging societies. However, differentiating between EORA and polymyalgia rheumatica (PMR) is challenging for clinicians and hinders the initiation of effective treatment for rheumatoid arthritis among older generations, thereby allowing its progression. Therefore, we conducted a qualitative synthesis of narrative reviews via meta-ethnography regarding seronegative EORA diagnosis to clarify the methods to differentiate seronegative EORA from PMR. Three databases (PubMed, EMBASE, and Web of Science) were searched for relevant reviews published between January 2011 and October 2022. The extracted articles were synthesized using meta-ethnography, and 185 studies were selected following the protocol. Seven reviews were analyzed, and four themes and nine concepts were identified. The four themes included difficulty in differentiation, mandatory follow-up, and factors favoring rheumatoid arthritis and those favoring PMR. Factors favoring seronegative EORA and PMR should be considered for effective diagnosis and prompt initiation of disease-modifying anti-rheumatic drugs. Mandatory and long follow-ups of suspected patients are essential for differentiating the two diseases. The attitude of rheumatologists toward tentatively diagnosing seronegative EORA and flexibly modifying their hypotheses based on new or altered symptoms can aid in effective management and avoiding misdiagnosis.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 690-0823, Japan
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Kosaka S, Nawata M, Yamazumi K, Nawata A, Nakamura K, Saito K, Tanaka Y. A case of giant cell arteritis complicated by polymyalgia rheumatica with scalp necrosis and refractory jaw claudication. Mod Rheumatol Case Rep 2023; 7:177-181. [PMID: 36315468 DOI: 10.1093/mrcr/rxac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/01/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
Scalp necrosis is a rare complication of giant cell arteritis (GCA); however, it is a predictor of severe disease. In this case study, a patient presented with GCA complicated by polymyalgia rheumatica with scalp necrosis. An 86-year-old woman was admitted to the hospital for pulsating headache, scalp pain, jaw claudication, and generalised pain. Bilateral temporal arteries were found to be distended and pulseless, and scalp necrosis was observed in the parietal region. Simultaneous high-resolution contrast-enhanced magnetic resonance imaging (MRI) sequences of the head, shoulder, and hip showed staining around the bilateral shallow temporal arteries, shoulder, and hip joints, which was confirmed as GCA with polymyalgia rheumatica using other examination findings. After treatment with early induction remission therapy, scalp necrosis healed, but jaw claudication persisted. Six months after the start of treatment, scalp necrosis was cured to full hair growth. Despite remission induction therapy combined with tocilizumab, the patient had persistent jaw claudication for several months. At that time, a high-resolution contrast-enhanced MRI re-examination was useful in assessing disease activity. GCA with scalp necrosis may cause prolonged jaw claudication reflecting the progression of ischaemic lesions, whereas the disease activity can be accurately assessed by combining MRI studies.
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Affiliation(s)
- Shumpei Kosaka
- Department of Clinical Immunology and Rheumatology, Tobata General Hospital, Kitakyushu, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masao Nawata
- Department of Clinical Immunology and Rheumatology, Tobata General Hospital, Kitakyushu, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kenji Yamazumi
- Department of Plastic surgery, Tobata General Hospital, Kitakyushu, Japan
| | - Aya Nawata
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Katsumi Nakamura
- Department of Radiology, Tobata General Hospital, Kitakyushu, Japan
| | - Kazuyoshi Saito
- Department of Clinical Immunology and Rheumatology, Tobata General Hospital, Kitakyushu, Japan
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Yamashita M, Aoki A, Kobayashi H, Wakiya M, Nakatsugawa M. [A case of giant cell arteritis after prednisolone dose reduction during treatment of polymyalgia rheumatica]. Nihon Ronen Igakkai Zasshi 2023; 60:440-447. [PMID: 38171762 DOI: 10.3143/geriatrics.60.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Giant cell arteritis (GCA) is closely associated with polymyalgia rheumatica (PMR). We herein report an 82-year-old woman who developed GCA during PMR treatment. She initially presented with shoulder pain and was diagnosed with PMR based on elevated serum C-reactive protein (CRP) levels and bursitis detected in both shoulders on ultrasonography (US). Treatment was initiated with a daily dose of 15 mg prednisolone (PSL), which led to rapid symptom alleviation, and the dosage was tapered to 1 mg/day. One month later, she developed myalgia extending from the lumbar region to the thigh and tenderness in the left temporal region. However, no abnormalities in the temporal artery were observed on US. Although the PSL dose was increased to 2 mg for relapse of PMR, the symptoms did not improve. One week later, she developed occipital pain with an increased CRP level of 9 mg/dL. She was diagnosed with GCA based on the 1990 ACR Classification Criteria. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) detected anomalous accumulations in the bilateral superficial temporal and vertebral arteries, but not in the larger vessels. We therefore diagnosed her with cranial-type GCA. At this time point, we repeated US and found a halo sign in the temporal artery. Although epithelioid and giant cells were not observed in the temporal artery biopsy, vascular inflammatory findings such as disruption of the internal elastic lamina and chronic inflammatory cell infiltration were noted. Symptoms improved immediately and CRP levels decreased after the PSL dose was increased to 30 mg daily. To mitigate the risk of steroid-induced diabetes, tocilizumab was introduced, and gradual tapering of PSL was implemented. In conclusion, we encountered a case of GCA that developed after PSL reduction during the course of PMR. PET/CT confirmed intracranial artery inflammation and facilitated a definitive diagnosis. Although PET/CT cannot be routinely performed for diagnose in Japan, we consider it useful as an adjunctive diagnostic tool.
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Affiliation(s)
- Mayu Yamashita
- Post-graduate Clinical Training Center, Tokyo Medical University Hachioji Medical Center
| | - Akiko Aoki
- Department of Rheumatology, Tokyo Medical University Hachioji Medical Center
| | - Hiroshi Kobayashi
- Department of Rheumatology, Tokyo Medical University Hachioji Medical Center
| | - Midori Wakiya
- Department of Pathology, Tokyo Medical University Hachioji Medical Center
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Walz K, Elliott L, Pearson T. Alternatives to glucocorticoid monotherapy in the treatment of polymyalgia rheumatica. J Am Assoc Nurse Pract 2022; 34:1263-1270. [PMID: 35944226 DOI: 10.1097/jxx.0000000000000756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment of polymyalgia rheumatica (PMR) can be challenging. The most efficacious and cost-effective treatment of PMR is some type of glucocorticoid (GC), with necessary treatment duration typically one year or longer. This duration of GC use is often associated with significant morbidity. Numerous studies have been and are being conducted that focus on alternative treatment modalities. OBJECTIVES This literature review explores alternatives to glucocorticoid monotherapy in the treatment of PMR. DATA SOURCES An integrative literature review was conducted to evaluate peer-reviewed literature on the topic. An electronic literature search was performed in the Cochrane Database of Systematic Reviews, and an EBSCO search identified relevant articles in the following databases: MEDLINE Complete, Academic Search Premier, Cumulative Index of Nursing and Allied Health (CINAHL) Plus, PsycInfo, Education Source, SocINDEX, the CDC, and PubMed. CONCLUSIONS Agents such as methotrexate and tocilizumab have been used successfully in conjunction with oral glucocorticoids and have demonstrated steroid-sparing effects. A promising adjunctive treatment is the monoclonal antibody, tocilizumab, which has been studied as both adjuvant and monotherapy. Further research in the efficacy, safety, and affordability of these agents is warranted. IMPLICATIONS FOR PRACTICE Because PMR is commonly diagnosed and managed in primary care, providers should keep abreast of the most current recommendations concerning optimal treatment options and carefully weigh the risks versus benefits of long-term GC use. This expanding area of research may assist primary care providers to better treat and manage PMR as well as reduce long-term treatment risk by minimizing corticosteroid use when possible.
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Affiliation(s)
- Kirsten Walz
- MS(N) Family Nurse Practitioner Program, School of Nursing, Western Carolina University, Asheville, NC
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Affiliation(s)
- Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich
| | - Helen Twohig
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele
| | - Humphrey Hodgson
- Polymyalgia Rheumatica & Giant Cell Arteritis UK, London, UK
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Boukhlal S, Felten R, Gervais E, Grardel B, Le Cam Y, Gottenberg JE, Saraux A, Devauchelle-Pensec V. Polymyalgia rheumatica associated with primary Sjögren's syndrome: A French multicentric retrospective study. Joint Bone Spine 2022; 89:105447. [PMID: 35940546 DOI: 10.1016/j.jbspin.2022.105447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Sara Boukhlal
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France.
| | - Renaud Felten
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France; Laboratoire d'Immunopathologie et de chimie thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, Strasbourg, France
| | | | | | - Yoann Le Cam
- Service de rhumatologie, CHU de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, centre national de référence des maladies autoimmunes et systémiques rares (CNR RESO), CHU de Strasbourg, hôpital de Hautepierre, Strasbourg, France; Laboratoire d'Immunopathologie et de chimie thérapeutique, Institut de Biologie Moléculaire et Cellulaire (IBMC), CNRS UPR3572, Strasbourg, France
| | - Alain Saraux
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France; Université de Brest, Lymphocytes B et Autoimmunité (LBAI), Inserm UMR1227, LabEx IGO, Brest, France
| | - Valérie Devauchelle-Pensec
- Service de rhumatologie, centre national de référence des maladies autoimmunes du Nord et du Nord-Ouest (CERAINO), CHU de Brest, Brest, France; Université de Brest, Lymphocytes B et Autoimmunité (LBAI), Inserm UMR1227, LabEx IGO, Brest, France
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Devauchelle-Pensec V, Carvajal-Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel BJ, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A. Effect of Tocilizumab on Disease Activity in Patients With Active Polymyalgia Rheumatica Receiving Glucocorticoid Therapy: A Randomized Clinical Trial. JAMA 2022; 328:1053-1062. [PMID: 36125471 DOI: 10.1001/jama.2022.15459] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Few treatments are available for patients with glucocorticoid-dependent polymyalgia rheumatica. IL-6 antagonists may reduce disease activity in patients with active glucocorticoid-dependent polymyalgia rheumatica. OBJECTIVE To compare the efficacy of tocilizumab vs placebo in patients with glucocorticoid-dependent polymyalgia rheumatica. DESIGN, SETTING, AND PARTICIPANTS This double-blind, parallel-group, placebo-controlled randomized clinical trial enrolled 101 patients with polymyalgia rheumatica at 17 hospitals in France from February 2017 to October 2019. Final follow-up occurred in November 2020. Inclusion criteria were persistent disease activity (polymyalgia rheumatica activity score computed using the C-reactive protein level [CRP PMR-AS] >10) and prednisone dose greater than or equal to 10 mg per day. INTERVENTIONS Patients were randomly assigned to receive intravenous tocilizumab (8 mg/kg; n = 51) or placebo (n = 50) every 4 weeks for 24 weeks, combined with predefined standardized tapering of oral prednisone. MAIN OUTCOMES AND MEASURES The primary efficacy end point was CRP PMR-AS less than 10 (range, 0-100; higher values indicate greater activity; no minimal clinically important difference defined) combined with either prednisone dose less than or equal to 5 mg per day or a decrease in prednisone dose greater than or equal to 10 mg from baseline at week 24. There were 11 secondary outcomes assessed at week 24 included in this report, including disease activity (measured by CRP PMR-AS) and the proportion of patients no longer taking prednisone. RESULTS Of the 101 randomized patients (mean age, 67.2 years; 68 [67.3%] women), 100 (99%) received at least 1 infusion and 100 completed the trial. The primary end point was achieved in 67.3% of patients in the tocilizumab group and 31.4% of patients in the placebo group (adjusted difference, 36.0% [95% CI, 19.4%-52.6%]; adjusted relative risk, 2.3 [95% CI, 1.5-3.6]; P < .001). Of 11 reported secondary end points at 24 weeks, 7 showed significant differences favoring tocilizumab, including mean CRP PMR-AS score (7.5 [95% CI, 5.4-9.6] vs 14.9 [95% CI, 11.4-18.4]; adjusted difference, -7.5 [95% CI, -11.2 to -3.8]; P < .001) and the percentage of patients no longer receiving prednisone (49.0% vs 19.6%; adjusted difference, 29.3% [95% CI, 18.9%-39.7%]; adjusted relative risk, 2.5 [95% CI, 1.8-3.5]; P < .001). The most frequent adverse events were infections, experienced by 23 patients (46.9%) in the tocilizumab group and 20 (39.2%) in the placebo group. CONCLUSIONS AND RELEVANCE Among patients with active polymyalgia rheumatica despite prednisone therapy, tocilizumab, compared with placebo, resulted in a significantly greater percentage of patients with a CRP PMR-AS less than 10 with reduced prednisone requirements at week 24. Further research is needed to confirm efficacy and to determine the balance of potential benefits and harms. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02908217.
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Affiliation(s)
- Valérie Devauchelle-Pensec
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | - Guillermo Carvajal-Alegria
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | | | - Christophe Richez
- Rheumatology Department, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Marie-Elise Truchetet
- Rheumatology Department, Bordeaux University Hospital and Bordeaux University, Bordeaux, France
| | - Daniel Wendling
- Rheumatology Department, Besançon Regional University Hospital and Bourgogne Franche-Comté University, Besançon, France
| | - Eric Toussirot
- INSERM CIC-1431 Clinical Investigations Center, Besançon University Hospital Besançon, France
| | - Aleth Perdriger
- Rennes 1 University, School of Medicine, South Hospital, Rheumatology Department, Rennes, France
| | | | - Renaud Felten
- Department of Rheumatology, Strasbourg University Hospitals, Strasbourg, France
| | - Bruno Jean Fautrel
- Sorbonne Université - Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière Hospital, Rheumatology Department, Paris, France
| | - Laurent Chiche
- Internal Medicine Department, European Hospital, Marseille, France
| | - Pascal Hilliquin
- Department of Rheumatology, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France
| | | | | | - Guillaume Direz
- Rheumatology Department, Community Hospital, Le Mans, France
| | | | - Divi Cornec
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
| | - Dewi Guellec
- Clinical Investigations Centre (CIC) 1412, National Health and Medical Research Institute (INSERM), Brest, France
| | | | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Brest, France
| | - Alain Saraux
- Rheumatology Department, Brest University Hospital, Brest, France
- INSERM 1227, Brest University, Brest, France
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ÖZTAŞ M, ÖZGÜL H, SEYAHİ E, UĞURLU S. Presentation characteristics and clinical outcome of patients with giant cell arteritis followed by a single center. Turk J Med Sci 2022; 52:917-925. [PMID: 36326373 PMCID: PMC10388098 DOI: 10.55730/1300-0144.5391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 08/10/2022] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Giant cell arteritis (GCA) is a large vessel vasculitis that may cause significant morbidity in the elderly population. We aimed to evaluate presentation characteristics, treatment, and outcome in a cohort of patients with GCA diagnosed and followed in a single center. METHODS A retrospective chart review revealed 84 (41 M/43 F) registered patients diagnosed with GCA between 1990 and 2020. Clinical features at presentation and follow-up, radiographical imaging, temporal artery biopsy (TAB), and laboratory findings were retrieved from digital medical records or hard-copy patient files. Of these, 33 patients' follow-up period was less than 12 months; hence, relapses and treatment outcomes were examined in the remaining 51 (60.5%) patients. RESULTS A total of 84 patients were included in the cohort. The mean age at diagnosis was 68.4 ± 7.9 years (range: 49-85). At presentation, 60 (71.4%) patients had headache, 22 (26.2%) had symptoms compatible with polymyalgia rheumatica (PMR), and 23 (27.4%) had visual loss. Three (3.6%) patients had solid organ malignancies while two had hematologic malignancies (2.4%) before GCA diagnosis. TAB was obtained in 63 (75%) patients, in 47 of whom (74.6%) the pathological findings were consistent with GCA. A PET/ CT scan has been performed before glucocorticoids (GCs) initiation in 43 (51.2%) patients and of these, 37 (86.0%) revealed uptake consistent with large vessel involvement. The median follow-up time of the 51 patients was 3.7 (IQR: 1.8-6.8) years. GCs were started promptly after the diagnosis. During the follow-up period, 28 (54.9%) patients experienced a relapse. Thirty-nine (78%) patients were under GC treatment, with a mean dosage of 4.8 ± 2.8 g/day at the final visit. At the final visit, 20.3% (17:84) had died whereas 9.8% (5:51) had permanent vision loss. DISCUSSION Treatment of GCA is challenging. GCA causes serious morbidities and increased mortality. PET/CT is highly effective in detecting large vessel vasculitis in GCA and could perhaps replace TAB in the future.
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Affiliation(s)
- Mert ÖZTAŞ
- Division of Rheumatology, Department of Medicine, İstanbul University-Cerrahpaşa, İstanbul,
Turkey
| | - Hamit ÖZGÜL
- Division of Rheumatology, Department of Medicine, İstanbul University-Cerrahpaşa, İstanbul,
Turkey
| | - Emire SEYAHİ
- Division of Rheumatology, Department of Medicine, İstanbul University-Cerrahpaşa, İstanbul,
Turkey
| | - Serdal UĞURLU
- Division of Rheumatology, Department of Medicine, İstanbul University-Cerrahpaşa, İstanbul,
Turkey
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Giovanna Colombo M, Wetzel AJ, Haumann H, Dally S, Kirtschig G, Joos S. Polymyalgia Rheumatica. Dtsch Arztebl Int 2022; 119:411-417. [PMID: 35635433 PMCID: PMC9533703 DOI: 10.3238/arztebl.m2022.0218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 02/15/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Polymyalgia rheumatica (PMR) is among the most common inflammatory rheumatic diseases in older adults. Presumed risk factors include female sex, previous infections, and genetic factors. No epidemiological data on PMR in Germany have been available until now. METHODS This review is based on publications retrieved by a selective literature search in PubMed. Moreover, the administrative incidence and prevalence of PMR in the years 2011-2019 was determined from data of the AOK Baden-Württemberg statutory health insurance carrier for insurees aged 40 and older. In addition, we quantified the number of consultations with physicians involved in the diagnosis. RESULTS The annual age- and sex-standardized incidence and prevalence of PMR from 2011 to 2019 were 18.6/100 000 persons and 138.8/100 000 persons, respectively. The incidence was higher in women than in men (21.8/100 000 vs. 12.8/100 000 persons per year). 60% of the cases were diagnosed in primary care practices. The treatment of PMR with orally administered glucocorticoids usually results in a treatment response within a few days to weeks. Approximately 43% of patients experience recurrent symptoms within a year, requiring adjustment of the glucocorticoid dose. For older patients with impaired physical ability, additional non-pharmacological treatment with exercise programs plays an important role. CONCLUSION PMR usually takes an uncomplicated course under treatment and can be managed in primary care, but these patients are often multimorbid and require frequent follow-up. Along with research on the etiology of the disease, further studies are needed to identify the risk factors for a chronic course and to evaluate the potential effects of non-pharmacological measures.
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Affiliation(s)
| | - Anna-Jasmin Wetzel
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen
| | - Hannah Haumann
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen
| | - Simon Dally
- Department of Analytics and Data Science, AOK Baden–Württemberg, Stuttgart
| | | | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tübingen
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Abstract
We herein report a 71-year-old woman presented with a fever, arthralgia, general malaise and leg muscle stiffness following administration of the COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). Laboratory findings showed an elevated C-reactive protein level and erythrocyte sedimentation rate. In addition, Gallium-67 scintigraphy demonstrated an increased uptake in multiple joints. Typing of human leukocyte antigen (HLA) revealed the presence of the DRB1*0404/*0803 allele. These findings met the diagnostic criteria for polymyalgia rheumatica (PMR), and when we started steroid treatment, her symptoms improved rapidly. This patient developed PMR after receiving a COVID-19 mRNA vaccine (Comirnaty, Pfizer-BioNTech). This case is considered to be valuable, as the HLA-DRB1 allele was also confirmed.
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Affiliation(s)
- Akira Yokote
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | | | - Takayasu Mishima
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University School of Medicine, Japan
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Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are considered 2 diseases on the same spectrum due to their many underlying similarities. In recent years, both diseases have witnessed both diagnostic and treatment advances, which shaped the way we manage them. In this article, the authors focus on different diagnostic modalities in GCA as well as the presence of different clinical phenotypes and the role of screening for aortic involvement. The authors also discuss traditional treatments and the role of evolving steroid-sparing agents in the management of both GCA and PMR.
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Affiliation(s)
- Sarah El Chami
- The University of Kansas Health System, 4000 Cambridge Street, MS 2026, Kansas City, KS 66160, USA
| | - Jason M Springer
- Vanderbilt University Medical Center 1161 21st Avenue South, T-3113 Medical Center North Nashville, TN 37232-2681, USA.
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