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PubMed1986

Polymyalgia rheumatica and temporal arteritis.

Polymyalgia rheumatica and temporal arteritis are a clinical syndrome and clinicopathologic entity, respectively. Polymyalgia rheumatica occurs more commonly than temporal arteritis, with approximately half of all patients with temporal arteritis having the polymyalgia rheumatica syndrome. Both conditions are found in the population over 50 years of age and are associated with an elevated ESR. The etiology of both is unclear, although genetic, and potentially, environmental factors may play significant roles. Both conditions respond to corticosteroid therapy, but patients with temporal arteritis require significantly higher doses to control symptoms and to prevent blindness.

Adrenal Cortex Hormones↗
PubMed1990

Polymyalgia rheumatica and temporal arteritis.

Polymyalgia rheumatica and temporal arteritis are separate but overlapping rheumatic diseases commonly seen among elderly persons. Polymyalgia rheumatica is characterized by upper body and trunk myalgias/arthralgias and an elevation in erythrocyte sedimentation rate. In about half of patients, temporal arteritis begins after polymyalgia rheumatica. Temporal arteritis is a systemic granulomatous disease that predominantly affects branches of the carotid artery. Claudication of the muscles of mastication and a painful burning tongue may develop during temporal arteritis or be the initial presenting symptoms. Recognition that these orofacial manifestations may be part of the disease process is mandatory because one third of patients with untreated temporal arteritis may go blind.

Aged↗
PubMed1986

[Paraneoplastic polymyalgia rheumatica. Case contribution].

Polymyalgia rheumatica (PMR) is an inflammatory disease which mainly affects the elderly and is highly responsive to steroid therapy. PMR can be associated with giant cell arteritis as well as with malignancy. Three cases of malignant neoplasms of the digestive apparatus beginning with a clinical picture similar to that of the "idiopathic" PMR, but with poor response to steroid therapy are presented. In one case the primary neoplasm was found only at the autopsy. These observations suggest that a careful clinical evaluation and a long follow-up are necessary for a correct diagnosis of "idiopathic" PMR.

Aged↗
PubMed1997

Risk factors and predictive models of giant cell arteritis in polymyalgia rheumatica.

OBJECTIVE: To identify in polymyalgia rheumatica the best set of predictors for a positive temporal artery biopsy and to define predictive models with either a high or low probability of giant cell arteritis (GCA). PATIENTS AND METHODS: Retrospective study of 227 patients, 137 with polymyalgia rheumatica unassociated with arteritis (group A) and 90 with polymyalgia associated with biopsy-proven giant cell arteritis (group B or training set). Data on demographic features, clinical and laboratory abnormalities were collected. Risk factors for arteritis were estimated by nonlinear logistic regressions. Simple predictive models were constructed with those predictors more related to arteritis by multivariable analysis. These models were then tested in group B and in 89 cases of arteritis without polymyalgia rheumatica (group C or test set). RESULTS: The best predictors of arteritis were a new headache odds ratio (OR) 13.6 (95% confidence interval [CI] 4.7 to 39.3); age at onset < 70 years OR 0.11 (CI 0.04 to 0.35); abnormal temporal arteries OR 4.2 (CI 1.3 to 13.7); raised liver enzymes OR 2.9 (CI 1.1 to 7.8), and jaw claudication OR 4.8 (CI 1.0 to 22.7). Amaurosis was only observed in patients with arteritis. Three subsets had a very high risk of arteritis: (1) Patients with recent headache, abnormal arteries, and > or = 70 years at disease onset: sensitivity 44%, positive predictive value (PPV) 93%, likelihood ratio (LR) 20.3; (2) patients with a new headache, jaw claudication, and abnormal arteries: sensitivity 34.4%, PPV 96.9%, LR 47.2; and (3) those, that in addition to the last 3 features, were > or = 70 years of age at disease onset: sensitivity 26.7%, PPV 100%. We could also identify a subset with a very low risk of arteritis constituted by patients < 70 years, without headache, and with clinically normal temporal arteries: sensitivity 1.1%, PPV 1.7%, LR 0.03. In group C or the test set, these four predictive models correctly identified 57.3%, 29.2%, 23.6, and 3.4% of patients, respectively. CONCLUSIONS: In polymyalgia rheumatica it is feasible to identify subsets with a very high likelihood of GCA. Although in some of these subsets the diagnosis of arteritis is almost certain, we suggest that even then it should be confirmed by temporal artery biopsy. By contrast, in those patients with polymyalgia < 70 years and without cranial features of giant cell arteritis, the risk of vasculitis is so low that the biopsy could be initially avoided and the patient treated with low-dose corticosteroids.

Aged↗
PubMed2003

[Study of lymphocyte subpopulations in chronic autoimmune inflammatory rheumatic diseases. I) Polymyalgia rheumatica].

AIM: The polymyalgia rheumatica (PMR) is a chronic autoimmune inflammatory rheumatic disorder, characterised by pain and stiffness on the shoulder and pelvic girdles, increasing of erythrocyte sedimentation rate (ESR) and good clinical and laboratory recovery by steroid therapy with a good outcome of the disease. There is now a wide agreement about an alteration of the distribution of lymphocyte subpopulations, characterised by a decreasing of CD8+ subset, at the onset of PMR. The aim of this paper is to study the distribution of lymphocyte subpopulations and their soluble receptors and the distribution of CD4+ and CD8+ subsets in patients with active PMR. METHODS: Forty-eight patients (9 males and 39 females, mean age 69.4+/-6.5 years) with active PMR (ESR 74+/-18 mm, 1st hour) were studied. In order to determine the distribution of lymphocyte subpopulations a panel of monoclonal antibodies was utilised. Flow cytometry was performed with a FACSCAN machine. RESULTS: The absolute number of CD4-/CD8+ cells were reduced (p<0.05) in comparison to normal subjects (356+/-112/ml vs 564+/-132/ml); the reduction was due to a decrease (p<0.001) of CD8+bright cells (224+/-86/ml vs 426+/-124/ml) and of CD8+bright/CD57- subset (123+/-44/ml vs 256+/-58/ml); an increase (p<0.001) of sCD8 (514+/-123 U/ml vs 312+/-102 U/ml) and an increase (p<0.0005) of sIL-2r (984+/-346 U/ml vs 244+/-58 U/ml) were also observed in comparison to normal subjects. No alterations of CD4+/CD8, CD8+bright/CD57+, CD8+dim/ CD57+/- cells and sCD4 were observed. CONCLUSION: Our study seems to confirm that in early and active PMR there are significant alterations of lymphocyte subpopulations and their subsets as well as of soluble receptors.

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PubMed2001

[Polymyalgia rheumatica in general practice].

BACKGROUND: Polymyalgia rheumatica is often diagnosed and treated in general practice. Rheumatologists have expressed concern about overdiagnosing and steroid treatment that conceals other diseases and deteriorating osteoporosis. MATERIAL AND METHODS: A ten-year material (1985-94) of polymyalgia rheumatica from a Norwegian general practice. RESULTS: Six out of 54 patients with the diagnosis polymyalgia rheumatica had their diagnose changed after one year. Average prednisolone starting dose was 31 mg, median treatment time for women was 20 months and for men 29 months. 10% were treated more than ten years, and 20% relapsed. Patients with fractures in the follow-up period had longer treatment periods; this indicates that a shorter treatment time may be important in preventing osteoporosis. INTERPRETATION: Diagnosing polymyalgia rheumatica can be done in general practice if there is good communication with second-line medical-services in cases with indistinct or serious symptoms. It is important to have in mind temporal arteritis, rheumatoid arthritis and malignancies. Treatment and follow-up of these patients is a task that needs stable and continuous relations between patient and doctor with special focus on the osteoporosis problem.

Aged↗
PubMed2006

Polymyalgia rheumatica and breast cancer.

Polymyalgia rheumatica is infrequently the initial manifestation of underlying malignancy. A patient is described with infiltrating ductal carcinoma of the breast presenting with left breast mass and polymyalgia rheumatica (PMR)-like symptoms. Physicians should consider an associated malignancy in PMR when patients present with atypical features such as young age, modest elevation of the sedimentation rate, and incomplete response to corticosteroids.

Biopsy, Needle↗
PubMedDate not supplied

[Appearance of giant cell arteritis 6 years after the 1st manifestation of polymyalgia rheumatica].

A case of polymyalgia rheumatica in a 70 year old woman is described. The patient was treated for 6 years with corticosteroids. Seven months after withdrawal of treatment, a severe relapse of polymyalgia rheumatica appeared which was connected with a histologically and immunohistochemically proved temporal arteritis. The problem of the duration of steroid treatment and the need for continued clinical as well as laboratory follow-up after withdrawal of therapy are discussed.

Aged↗
PubMed1980

[Ocular involvement in polymyalgia rheumatica (author's transl)].

Polymyalgia rheumatica is a disease of the elderly, more common in women. Pain and stiffness localized in the proximal extremities respond well to low-dose corticosteroids. In roughly half of the cases, giant cell arteritis can be detected in apparently normal temporal arteries. There is no danger of ocular involvement in "pure" polymyalgia rheumatica, even with a positive biopsy. When cranial symptoms, such as headache or tenderness of the temporal arteries, appear, there is a great danger of ocular involvement, and high-dose corticosteroid treatment is advisable.

Adrenal Cortex Hormones↗
PubMed1989

Polymyalgia rheumatica. Clinical features and management.

Polymyalgia rheumatica is a clinical syndrome that occurs almost exclusively in older patients. It is characterized by muscle aching and stiffness and an elevated erythrocyte sedimentation rate. It must be distinguished from other common disorders, particularly polymyositis, fibromyalgia, and other chronic inflammatory or neoplastic diseases. A temporal artery biopsy should be done in patients with confirmed polymyalgia rheumatica and suspected coexistent temporal arteritis, which can have serious manifestations. Patients with polymyalgia rheumatica respond dramatically to low doses of corticosteroids, although prolonged daily treatment often may be needed.

Aged↗
PubMed2006

Polymyalgia rheumatica and giant cell arteritis.

Polymyalgia rheumatica and giant cell arteritis are common, closely related vasculitic conditions that almost exclusively occur in patients older than 50 years. They may be manifestations of the same underlying disease and often coexist. Patients with polymyalgia rheumatica usually present with acute onset of stiffness and pain in the shoulder and pelvic musculature, which may be accompanied by fever, malaise, and weight loss. If untreated, polymyalgia rheumatica may result in significant disability. Giant cell arteritis may manifest as visual loss or diplopia, abnormalities of the temporal artery such as tenderness or decreased pulsation, jaw claudication, and new-onset headaches. Erythrocyte sedimentation rate and temporal artery biopsy help make the diagnosis. Giant cell arteritis requires urgent diagnosis because without treatment it may lead to irreversible blindness. Patients with either condition also may have nonspecific symptoms. Corticosteroids are the mainstay of therapy for both conditions, with higher doses required for treatment of giant cell arteritis. Duration of corticosteroid therapy can be five years or longer before complete clinical remission is achieved. Monitoring for corticosteroid-associated side effects such as osteoporosis and diabetes, as well as for relapses and flare-ups, is key to chronic management. The prognosis for either condition, if treated, is good.

Aged↗
PubMed2000

Management of giant cell arteritis and polymyalgia rheumatica.

Giant cell arteritis and polymyalgia rheumatica are closely related disorders that affect persons more than 50 years of age and cause substantial morbidity. Patients with giant cell arteritis typically have a localized headache, nonspecific systemic symptoms, temporal artery tenderness and a high erythrocyte sedimentation rate (ESR). The diagnosis is confirmed by characteristic pathologic findings on temporal artery biopsy. Patients with polymyalgia rheumatica usually have similar nonspecific systemic symptoms, proximal muscle pain and stiffness, and an elevated ESR. The diagnosis is based on the clinical findings. Both disorders are treated with corticosteroids: high dosages for giant cell arteritis (prednisone in a dosage of 40 to 60 mg per day) and lower dosages for polymyalgia rheumatica (prednisone in a dosage of 10 to 20 mg per day). Symptom relief in response to treatment is rapid and reinforces the diagnosis. After normalization of the ESR, the corticosteroid is tapered, with the patient monitored closely for symptom recurrence. Most patients require corticosteroid therapy for two to three years and experience one or more treatment complications.

Giant Cell Arteritis↗
PubMed2001

Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica.

OBJECTIVE: Joint inflammation in polymyalgia rheumatica is regarded primarily as a disease of the synovial cavities and bursae, but the adjacent capsules and soft tissues have not been evaluated using sensitive imaging methods. We used fat suppression magnetic resonance imaging (MRI) to determine anatomical sites of inflammatory change in the shoulders of patients with early polymyalgia rheumatica (PMR) and a control group of patients with rheumatoid arthritis (RA). METHODS: Fourteen patients with PMR and 14 with RA (a total of 20 shoulders in each group) were evaluated. T2 SPIR (fat suppressed) coronal oblique MRI sequences of the shoulders were performed. Scans were assessed for sites of joint effusion, bursitis, tenosynovitis, bone edema, and extracapsular soft tissue edema. Statistical analysis was performed using Fisher's test. RESULTS: Nine of 14 patients (10/20 joints) with PMR but only 2/14 (2/20 joints) with RA had prominent edema at extracapsular sites adjacent to the joint capsule or in the soft tissues (p = 0.02). Both groups had a comparable degree of joint effusion (18 PMR, 17 RA), bursitis (18 PMR, 16 RA), and tenosynovitis (3 PMR, 2 RA). CONCLUSION: The only significant difference between the 2 groups was the presence of inflammatory change outside the joint cavity in patients with PMR. This may contribute to the diffuse nature of symptoms in PMR and have implications for its pathogenesis.

Adult↗
PubMed1991

Polymyositis, not polymyalgia rheumatica.

The distinction between polymyalgia rheumatica and polymyositis is important for treatment and prognosis. Four elderly patients were diagnosed and treated for polymyalgia: raised creatine kinase led to muscle biopsy and a diagnosis of polymyositis.

Aged↗
PubMed2006

The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970.

Giant cell arteritis and polymyalgia rheumatica were described separately more than 100 years ago. However, the original reports of both conditions were neglected for many years. After the article by Horton et al on giant cell arteritis in the 1930s and studies published by others in the 1940s, giant cell arteritis began to be recognized as a specific disease. In the 1950s and 1960s, many of the numerous presentations and complications of giant cell arteritis were recorded. In a somewhat similar fashion, physicians became cognizant of polymyalgia rheumatica only after several independent descriptions in the 1940s and 1950s. The rapid response of both syndromes to glucocorticoid therapy was discovered shortly after cortisone's effect on rheumatoid arthritis was described. The origin of the proximal aching and stiffness in polymyalgia rheumatica was more difficult to understand. The relatively minor findings in the joints on physical examination seemed insufficient to account for the severe discomfort. As the link between polymyalgia rheumatica and giant cell arteritis became apparent, some thought the aching in polymyalgia rheumatica was related to vasculitis. The debate about whether proximal synovitis or vasculitis was the cause of the symptoms continued after 1970. Although the reason these 2 conditions were associated was not considered by 1970, the establishment of the syndromes as clinically linked entities provided the groundwork for further progress in the next decades.

Denmark↗
PubMed1984

Hepatic granuloma in polymyalgia rheumatica.

Hepatic granuloma occurs rarely in the polymyalgia rheumatica syndrome. A case was presented of a 62-year-old woman with polymyalgia rheumatica, elevated concentrations of hepatic enzymes, and granuloma of the liver. Low doses of corticosteroids produced a marked improvement in the patient's condition and a return of liver function tests to normal. This is apparently the first case of polymyalgia rheumatica associated with liver granuloma that has been reported in Israel.

Female↗