[Polymyalgia rheumatica in general practice].
Explore the source record for details and available documents.
Family Practice↗
Biomedical subjects
J T Gran
Publications and source records attributed to J T Gran.
[Why are patients referred to outpatient clinic of rheumatology?].
BACKGROUND: Increasing numbers of patients are referred from general practitioners to out-patient clinics of rheumatology. Better selection of patients referred may shorten the long waiting lists. The study aimed at analysing causes of referrals with particular emphasis on determining which diagnostic problems that most often occur among such referrals. MATERIALS AND METHODS: All referrals from general practitioners to an out-patient clinic of rheumatology during one year were analysed. RESULTS: Diagnosis was the main cause of referral in 78% of the cases. The diagnosis of the specialist was identical to that of the general practitioner in 44% of the cases. The lowest degree of correlation was found for patients referred with rheumatoid arthritis and primary Sjögren's syndrome. INTERPRETATION: The diagnoses of rheumatoid arthritis and Sjögren's syndrome appear to be difficult in general practice.
Adolescent↗
[Diagnosis of primary Sjogren's syndrome].
BACKGROUND: The diagnosis of primary Sjögren's syndrome largely depends on pathological findings at lower lip biopsy, or the presence of anti SSA and/or anti SSB antibodies. The present study evaluated which clinical and laboratory features among patients with sicca symptoms could predict a positive biopsy. MATERIAL AND METHODS: All 217 patients evaluated for sicca symptoms at Aust-Agder Central Hospital, Arendal, Norway from 1989 through 1998 were retrospectively reviewed. RESULTS: 136 biopsies were performed. 59 patients were diagnosed with primary Sjögren's syndrome. A reduced Schirmer I test combined with either an elevated ESR, positive ANA or elevated serum gammaglobulin had a high positive predictive value for primary Sjögren's syndrome. INTERPRETATION: Among patients with sicca symptoms, those with laboratory evidence of inflammation, autoimmunity or exocrine dysfunction should be subjected to a lower lip biopsy for a final diagnosis of primary Sjögren's syndrome.
Adolescent↗
Total mortality is increased in rheumatoid arthritis. A 17-year prospective study.
The purpose of this study was to determine the total and cause-specific mortality in rheumatoid arthritis (RA) patients compared to a control population in northern Norway. One hundred and eighty-seven patients with RA and 930 population controls matched for age, gender and municipality were followed until death or for a maximum of 17 years. The total mortality in RA patients was twice that of their controls (MRR = 2.0, 95% CI = 1.6-2.5). Patients possessing serum rheumatoid factors did not have a higher relative mortality than the seronegative patients. There was no statistically significant increased mortality from cancer or cardiovascular diseases. Indications for a higher death rate in RA patients than in controls were found for infection and sudden death.
Adult↗
Changes in therapy of rheumatoid arthritis during the period 1979 to 1996.
OBJECTIVE: To evaluate the use of disease modifying antirheumatic drugs (DMARDs), cytotoxic agents, and corticosteroid therapy in patients diagnosed with rheumatoid arthritis (RA) in two periods, 1979 to 1987, and 1988 to 1996. MATERIALS AND METHODS: Review of the records of 788 patients with RA diagnosed at the Department of Rheumatology, the University Hospital of Tromsø. RESULTS: We found a significant increase in the proportion of patients who started with auranofin, sulfasalazine, methotrexate, and corticosteroids in 1988 1996 compared to 1979 1987. The initiation of use of gold salts, antimalarials, and D-penicillamine declined significantly from the first to the second period. CONCLUSION: Patients diagnosed with RA between 1988-1996 were treated more actively than patients diagnosed in the period 1979-1987. During 1988 to 1996 auranofin, sulphasalazine, methotrexate, and corticosteroids replaced gold salts, antimalarials, and D-penicillamine.
Antirheumatic Agents↗
Prednisolone maintenance dose in relation to starting dose in the treatment of polymyalgia rheumatica and temporal arteritis. A prospective two-year study in 273 patients.
OBJECTIVE: To describe the maintenance dose and annual cessation rate of oral corticosteroids in relation to the starting dose in patients with polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS: A prospective two-years observational study of 273 patients with PMR and TA followed by rheumatologists. RESULTS: Mean daily maintenance dose of prednisolone during the first and second year was 5.7 mg and 4.3 mg for PMR, 6.6 mg and 4.1 mg for TA, and 8.3 mg and 4.7 mg for PMR with TA. There was a strong association between the initial dose and maintenance dose. The rate of steroid cessation after two years in PMR was 24%, in TA 16%, and in PMR with TA 5%. CONCLUSION: Low initial dose of prednisolone is associated with low maintenance dose. This is important as the majority of patients with PMR and TA will be treated for more than two years.
Aged↗
Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls.
OBJECTIVE: To estimate survival in polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS: The present study encompassed 338 incident cases who were diagnosed at the Department of Rheumatology during the period 1987-1997 and 60 cases diagnosed in the same period but admitted to hospital for reasons other than PMR or TA. The 398 patients were each assigned four age- and sex-matched controls from the same population and mortality ascertained. RESULTS: Among the 338 incident cases, there were 69 deaths compared with 360 deaths among their 1352 controls. The mortality was thus 28% lower in cases than in controls [relative risk (RR)=0.72, 95% confidence interval (CI) 0.55-0.95]. The 274 incident cases with pure PMR had increased survival compared with controls (RR=0.70, 95% CI 0.52-0.95), whilst among the 64 incident TA patients and their controls, no difference in mortality was found (RR=1.2, 95% CI 0.55-2.74). Patients diagnosed at other departments and their controls had the same mortality. In the incident cases, the mean initial dose of prednisolone, the mean maintenance dose of prednisolone, the mean initial erythrocyte sedimentation rate and C-reactive protein and frequency of peripheral arthritis did not differ between survivors and those dying during the observation period. CONCLUSION: The study showed increased survival in patients with PMR compared with controls, whilst mortality in TA equalled that of controls. There was no association between use of corticosteroids and level of disease activity and death. The increased survival in PMR might be explained by improved medical surveillance.
Female↗
The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study).
OBJECTIVES: To estimate the occurrence of peripheral arthritis (PA) 6 yr after diagnosis of inflammatory bowel disease (IBD). METHODS: In a population-based cohort of 654 patients with a definite diagnosis of IBD, 521 patients (80%) were clinically examined by a rheumatologist 6 yr after IBD diagnosis. RESULTS: PA related to IBD (PAIBD) was detected at examination in four patients (point prevalence 0.8%). If the patients' own reports of PA were accepted, 12% of the cases had developed such manifestations. The striking difference may be explained by the nature of PAIBD exhibiting a short-lasting, self-limiting, non-destructive course and by possible differences in the validity of both methods of ascertainment. CONCLUSION: Our results indicate that PAIBD occurs in a considerable number of IBD patients during the first years after diagnosis, but the point prevalence of PAIBD is low.
Adolescent↗
Fibromyalgia and chronic widespread pain in patients with inflammatory bowel disease: a cross sectional population survey.
OBJECTIVE: To assess the prevalence of fibromyalgia (FM) and chronic widespread pain (CWP) in a population based cohort of patients with inflammatory bowel disease (IBD). METHODS: Patients in a prospective survey on newly diagnosed IBD were, 5 years after study entry, invited to a clinical examination including the investigation of musculoskeletal manifestations. A total of 521 patients were examined, corresponding to 80% of surviving cases with definite diagnoses of ulcerative colitis (UC) and Crohn's disease (CD). The diagnoses of FM and CWP strictly followed the American College of Rheumatology classification criteria of 1990. RESULTS: At clinical examination, FM was diagnosed in 18 patients (3.5%), 3.7% with UC and 3.0% with CD. The prevalence was 6.4% in females and 0.4% in males. Thirty-eight patients (7.3%) had CWP (8.5% with UC; 4.8% with CD). The female:male ratio was 27:3 in the UC group and 8:0 in CD. In 19 patients (50%), CWP occurred after onset of IBD. No correlation with the extent of intestinal inflammation and the occurrence of FM and CWP was found. CONCLUSION: The prevalences of FM and CWP in patients with IBD were similar to those of the general population. There were no differences in prevalence of FM and CWP between UC and CD. Chronic idiopathic inflammation of the intestine does not appear to predispose to chronic widespread pain.
Adolescent↗
High mortality in patients with rheumatoid arthritis and atlantoaxial subluxation.
OBJECTIVE: To study relationships between atlantoaxial subluxation (AAS) and total mortality in patients with rheumatoid arthritis (RA). METHODS: Radiological reports and clinical files of patients with RA were reviewed for the presence of cervical spine involvement verified by cervical radiographs. RESULTS: Among 241 patients with cervical radiographs, anterior AAS > or = 4 mm was found in 5% [95% confidence interval (CI) 2-8] of patients. Vertical and posterior subluxations were found in 1.4 and 0.5%, respectively. The mean observation time from RA diagnosis to AAS was 3.9 years. Patients with AAS had 8 times higher mortality than patients without AAS (95% CI 3-25). According to the death certificate, the patients died from cancer, stroke, and myocardial infarction. Cervical spine disorder was not mentioned on the death certificate. However, an autopsy was not performed. CONCLUSION: We found high mortality in RA patients with AAS. AAS in the cervical spine developed relatively early in the course of the disease. Analyses adjusted for seropositivity, erosiveness, and glucocorticosteroids did not reduce the mortality rate ratio. Our results underline the need for careful evaluation of patients with RA with respect to development of AAS.
Adult↗
[Polymyalgia rheumatica--an inconvenient diagnosis?].
Explore the source record for details and available documents.
Diagnosis, Differential↗
[Referrals from general practitioners to rheumatologists].
BACKGROUND: The study is an analysis of referrals of new patients from general practitioners to an outpatient clinic of rheumatology. MATERIAL AND METHODS: All referrals from general practitioners during a 12 months period were evaluated. RESULTS: The annual incidence of referrals of new patients was 423 per 100,000. The main cause of referral was diagnosis, and more than half of the diagnoses suggested were changed at the visit. Few of the referred patients had severe disease. INTERPRETATION: The selection of patients for specialist consultation in rheumatology should be changed in favour of patients with severe disease at the expense of those with long-standing non-debiliating disorders.
Adolescent↗
[Palindromic rheumatism].
BACKGROUND: Palindromic rheumatism is an inflammatory rheumatic disease characterised by recurrent attacks of arthritis confined to one or more peripheral joints. Each episode of arthritis rarely lasts more than 14 days, and subsides without leaving any residues. MATERIAL AND METHODS: Three patients with palindromic arthritis are presented, and the literature reviewed. RESULTS: The clinical and laboratory characteristics of the three patients were similar to those generally described for palindromic rheumatism. Two patients developed seropositive rheumatoid arthritis and one patient developed chronic seronegative polyarthritis. INTERPRETATION: Palindromic rheumatism may evolve into chronic polyarthritis.
Arthritis↗
[Felty's syndrome].
BACKGROUND: Felty's syndrome is a complication of rheumatoid arthritis whereby patients develop neutropenia of varying severity and splenomegaly. The major sources of morbidity and mortality are recurrent local and systemic infections, although some patients remain asymptomatic. MATERIAL AND METHODS: In this paper two patients with Felty's syndrome are presented. RESULTS: One patient had recurrent infections. Clinical manifestations, laboratory features and different modalities of treatment are reviewed. INTERPRETATION: Splenectomy has long been standard therapy, but disease modifying antirheumatic drugs (such as gold salts and methotrexate) and colony stimulating factors should also be considered in Felty's neutropenia complicated with infections.
Aged↗
Referrals from general practice to an outpatient rheumatology clinic: disease spectrum and analysis of referral letters.
Our objective was to study the demographic characteristics of patients referred from general practitioners to a rheumatology outpatient clinic and to analyse the content and quality of the referral letters. During a 12-month period 346 randomly chosen referral letters of new patients from GPs to a rheumatology outpatient clinic were evaluated. The mean age of the 346 referred patients (73.1% females and 26.9% males) was 45.5 years and 17.8% were 60 or older. Mean disease duration at the time of referral was 50.9 months (1-432 months). Only about 10% of the patients referred had a disease duration of 1 month or less. The current clinical problem was appropriately presented in 95% of the referral letters. In only 0.9% of referrals had there been a prior phone consultation. Altogether, 95.1% of the referrals were as a result of diagnosis or treatment, and in nearly half the cases a diagnosis of inflammatory rheumatic disease was suggested. In 23% of the letters the result of clinical examinations were missing. Laboratory tests such as serum rheumatoid factor, antinuclear antibodies and HLA-B27 were used by GPs to screen for rheumatic disease in general. A lack of correlation between clinical manifestations and subsequently requested laboratory examinations was frequently found in the referral letters, exemplified by the use of HLA-B27 in rheumatoid arthritis and serum rheumatoid factors in ankylosing spondylitis. These results show that among GPs the threshold for referring patients to a rheumatology outpatient clinic appears rather high, and that patients are subjected to long observation periods before referral. A more frequent use of phone consultations and an improvement in the diagnostic skills of GPs may positively influence the selection of patients for referral and shorten the long waiting lists in rheumatology. This need for improvement was further strengthened by GPs' inappropriate use of laboratory tests.
Adolescent↗
No permanent reduction in bone mineral density during treatment of polymyalgia rheumatica and temporal arteritis using low dose corticosteroids.
The objective of the study was to examine bone mineral density (BMD) in patients with polymyalgia rheumatica (PMR) or temporal arteritis (TA) currently or previously treated with prednisolone. BMD (using single or dual x-ray absorptiometry) was measured in radius, spine, and hip in 26 currently and 28 previously prednisolone treated patients with PMR (n = 38) or TA (n = 16). The prednisolone treated patients were compared to 30 newly diagnosed PMR (n = 26) or TA patients (n=4) examined prior to start of prednisolone, and 70 healthy controls. No statistically significant differences were found between the groups regarding age, height, weight, and gender. For current users of prednisolone, the mean daily dose was 6.5 mg, the mean cumulative dose 7.7 grams, and for previous users 5.6 mg and 6.6 grams, respectively. No statistically significant differences in BMD at the different measurement sites were found between prednisolone treated patients and the two control groups. Similarly, no significant differences in BMD were found between current and previous users of prednisolone and between the prednisolone treated PMR and TA patients. In conclusion, BMD is not substantially reduced in PMR and TA patients currently or previously treated with mean low dose prednisolone. However, a tendency to a lower BMD was found in PMR/TA patients currently treated with prednisolone and in the prednisolone treated TA patients.
Absorptiometry, Photon↗
The incidence and clinical characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis: a prospective study of 231 cases.
OBJECTIVE: To evaluate the incidence and characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis, and to ascertain the incidence of rheumatoid arthritis among such cases. Patients and methods. In total, 231 patients were selected from a prospective population-based study. All patients were clinically examined on several occasions and followed until cessation of therapy and permanent disease remission. RESULTS: Of the 231 cases, 38.5% presented peripheral arthritis either at diagnosis or during the disease course. At diagnosis, peripheral arthritis was not observed among patients with temporal arteritis. Peripheral arthritis occurring during the disease course was more often polyarticular and needed additional treatment more frequently than joint inflammation presenting at diagnosis. Only one case had distal pitting oedema. Rheumatoid arthritis developed in 4.8% of the cases and exclusively among patients with polymyalgia rheumatica. CONCLUSION: Aetiopathogenic differences may exist between polymyalgia rheumatica and temporal arteritis as peripheral arthritis and the development of rheumatoid arthritis were observed among the former patient group only.
Aged↗