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PubMed1980

Circulating immune complexes in giant cell arteritis and polymyalgia rheumatica.

Sera from 74 patients with polymyalgia rheumatica or giant cell arteritis or both were tested for immune complexes by using the Raji cell radioimmunoassay. Levels in patients with active disease were higher than in patients whose disease had become inactive. There was no difference in levels of immune complex-like materials between patients with polymyalgia rheumatica alone and those with giant cell arteritis. Density gradient analysis of one serum showed immune complex-like materials mainly in the 19S region. Immune complexes may be important in the pathogenesis of these conditions.

Aged↗
PubMed2001

Polymyalgia rheumatica and temporal arteritis with sacroiliitis and osteitis pubis.

Polymyalgia rheumatica (PMR) and temporal arteritis (TA) have been associated with a seronegative polyarthritis that can mimic rheumatoid arthritis. Sacroiliitis and osteitis pubis are most often encountered in the different types of spondyloarthropathy. However, sacroiliitis and osteitis pubis have rarely been described in patients with polymyalgia rheumatica and temporal arteritis. We present two patients, one with temporal arteritis and the other with polymyalgia rheumatica, who also had many features of a spondyloarthropathy, including sacroiliitis and osteitis pubis. In reviewing the literature, we found 30 other patients with a diagnosis of PMR who also had sacroiliitis and/or osteitis pubis. We propose that the inflammatory arthritis associated with polymyalgia rheumatica and temporal arteritis can involve the axial joints, resembling a spondyloarthropathy. It is important for the clinician to recognize that sacroiliitis and osteitis pubis have been associated with PMR and TA so that their radiographic presence does not dissuade the clinician from making the correct diagnosis.

Journal Article↗
PubMedDate not supplied

[Methotrexate therapy of polymyalgia rheumatica].

Twenty-seven patients with polymyalgia rheumatica were treated with methotrexate. In comparison with 295 patients with other inflammatory rheumatic diseases under methotrexate therapy, a favorable rate of therapeutic effect and a low rate of side-effects could be observed. Remissions appeared in the mean after 6 months (1-24 months). Therapeutic failures (1/27) or side-effects inducing breaking off the therapy (2/27) were rare. Methotrexate seems to be a useful possibility to supplement the corticosteroid therapy of polymyalgia rheumatica.

Adult↗
PubMed1997

Joint manifestations in myelodysplastic syndromes. A report of three cases presenting as polymyalgia rheumatica.

We report three cases of polymyalgia rheumatica occurring after (n = 1) or shortly before (n = 2) a diagnosis of myelodysplastic syndrome. These cases demonstrate that: 1) inflammation and bleeding are not the only causes of anemia in patients with inflammatory joint disease; 2) side effects of drugs, Felty's syndrome and large granular lymphocyte expansion are not the only causes of neutropenia in this setting; 3) lymphomas and monoclonal gammopathies are not the only hematologic diseases that can present under the guise of polymyalgia rheumatica; 4) a high index of suspicion for a myelopoietic disorder should be maintained in patients who have not only joint symptoms and cytopenia, but also vasculitis, neurologic symptoms, thyroid disorders or protein electrophoresis abnormalities. Because myelodysplastic syndromes are due to clonal proliferation of abnormal stem cells, our cases are in line with recent investigations suggesting that abnormalities of bone marrow stem cells are involved in the pathogenesis of some inflammatory joint diseases. Studies of the clonality and karyotype of synovial cells from affected joints might lend further support to this hypothesis.

Aged↗
PubMed1995

[Polymyalgia rheumatica as the presenting symptom of multiple myeloma].

Polymyalgia rheumatica is a clinical syndrome which appears after the age of 50 and is characterized by pain and stiffness of proximal muscles, rapid sedimentation rate and a dramatic response to small doses of corticosteroids. The linkage between polymyalgia rheumatica and temporal arteritis is well-known, but the connection with monoclonal gammopathy and lympho-proliferative disorders has rarely been reported. We present a 74-year-old man admitted with the typical clinical picture of polymyalgia rheumatica, which was the presenting symptom of monoclonal gammopathy and subsequently-diagnosed multiple myeloma.

Aged↗
PubMed1984

[Polymyalgia rheumatica and giant cell arteritis].

Among 47 patients with polymyalgia rheumatica there were 30 (63.8%) with temporal giant-cell arteritis. Rapidly progressing visual reduction occurred in 2, acute blindness in 10. Four forms of polymyalgia rheumatica were identified by their different clinical courses, with differing risk of blindness. Those patients with polymyalgia rheumatica and giant-cell arteritis are most endangered who have headaches and neck and shoulder pains, but no or only mild general symptoms.

Aged↗
PubMed1997

Proximal bursitis in active polymyalgia rheumatica.

BACKGROUND: The cause of musculoskeletal symptoms in the proximal extremities of patients who have polymyalgia rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. OBJECTIVE: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of polymyalgia rheumatica. DESIGN: Case-control study. SETTING: 2 secondary referral centers of rheumatology. PATIENTS: 13 case-patients who had active symptoms of polymyalgia rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. MEASUREMENTS: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. RESULTS: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had polymyalgia rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. CONCLUSIONS: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with polymyalgia rheumatica.

Aged↗
PubMed1994

[Polymyalgia rheumatica and temporal arteritis. New aspects of diagnosis, treatment, prognosis and risk of cancer].

The incidence of polymyalgia rheumatica and temporal arteritis is increasing, mainly in elderly people. The risk of cancer during a lifetime is high in patients with positive biopsy of the temporal artery, but polymyalgia rheumatica and temporal arteritis are not to be considered as paraneoplastic syndromes. Temporal arteritis can appear in patients under treatment for polymyalgia rheumatica, and polymyalgia rheumatica can be accompanied by arthritis. Various new aspects of diagnoses and treatment are discussed.

Giant Cell Arteritis↗
PubMed2000

Polymyalgia rheumatica--an underdiagnosed disease.

Characteristic features of polymyalgia rheumatica, a widely underdiagnosed disease, are described. The features of the disease are illustrated by the authors' own experience in the treated patients, and compared with literature data. According to the authors' experience, patients with polymyalgia rheumatica are mostly treated for inaccurate diagnoses such as cervicobrachial or lumbosacral syndrome, seronegative rheumatoid arthritis, unexplained febrile state, or precipitated erythrocyte sedimentation rate of unknown etiology. This results is delayed diagnosis or the accurate diagnosis is never reached at all.

Aged↗
PubMed1989

[Incidence of polymyalgia rheumatica at a department of internal medicine].

Polymyalgia rheumatica can be characterised by pain and stiffness in the shoulder and pelvic girdles, with a raised ESR and a dramatic response to corticosteroid therapy. Case reports and clinical symptoms of six patients with polymyalgia rheumatica are reported by the authors. All of the patients were female with mean age 54.3 years. 11.8 months were registered between the initial symptoms of the disease and the establishment of the diagnosis. This relatively long period of time can be caused by the poor recognition of the disease, besides the difficulties of the diagnosis.

Adrenal Cortex Hormones↗
PubMed1982

Polymyalgia rheumatica: a 10-year epidemiologic and clinical study.

Ninety-six patients with polymyalgia rheumatica were identified in Olmsted County, Minnesota, during the 10-year period 1970 to 1979. Giant cell arteritis was found in 15 of the 96 patients. The average annual incidence of polymyalgia rheumatica in the population increased from 19.8 per 100 000 in persons 50 to 59 years of age, to a maximum of 112.2 per 100 000 in persons 70 to 79 years of age. Eighty-three of the 96 patients (86%) had recovered by the end of the study. Median duration of the disease was 11 months (range, 2 to 54 months). Polymyalgia rheumatica had no effect on survival. Both corticosteroids and nonsteroidal anti-inflammatory drugs were used in treatment. Response was more rapid in patients given corticosteroids, but nonsteroidal drugs were used successfully, especially in milder cases. Relapses and adverse reactions to treatment were more frequent in patients given corticosteroids. The findings show that polymyalgia rheumatica is a relatively common disease in middle-aged and older persons and generally runs a self-limited course.

Age Factors↗
PubMed1992

Simultaneous occurrence of polymyalgia rheumatica in a married couple.

The case of a married couple who simultaneously developed polymyalgia rheumatica is presented. Both patients responded to steroid treatment, and when the steroid dose was gradually reduced both patients relapsed. The aetiology and pathogenesis of polymyalgia rheumatica remain unclear; familial aggregation indicates the involvement of genetic factors, whereas conjugal aggregation indicates infectious/environmental agents. In previous reports of polymyalgia rheumatica in married couples, the onset of symptoms in the two patients has usually been separated by a long chronological interval. It is concluded that the present report of simultaneous development of polymyalgia rheumatica in a married couple lends further support to an environmental or contagious aetiology.

Aged↗
PubMed1996

Antibodies to cardiolipin and beta 2 glycoprotein I in patients with polymyalgia rheumatica and giant cell arteritis.

IgG antibodies to cardiolipin and beta 2-glycoprotein I were looked for using an enzyme-linked immunosorbent assay (ELISA) in 19 patients with giant cell arteritis (meeting 1990 American College of Rheumatology criteria), including 16 with concomitant polymyalgia rheumatica (meeting Bird's criteria) and in three patients with isolated polymyalgia rheumatica. IgG anti-cardiolipin antibodies were demonstrated in eight patients (36%) and IgG anti-beta 2-glycoprotein I antibodies in two patients (9%) including one without anti-cardiolipin antibodies. Titers of anti-cardiolipin antibodies ranged from 27 to 190 units of IgG antiphospholipid antibodies (UGPL) (mean 71 UGPL). Of the eight patients with anti-cardiolipin antibodies, two had giant cell arteritis without polymyalgia rheumatica and six had polymyalgia rheumatica with clinical (n = 2) or histologic (n = 4) evidence of giant cell arteritis. None of the three patients with polymyalgia rheumatica but no giant cell arteritis had anti-cardiolipin or anti-beta 2 glycoprotein I antibodies. The VDRL was negative in the 14 patients who had this test. Tests for lupus anticoagulant were performed routinely, always with negative results. Among giant cell arteritis patients, those who tested positive for anticardiolipin antibody had significantly higher values for the erythrocyte sedimentation rate (p < 0.006) and for serum C-reactive protein (p < 0.03) and fibrinogen values (p = 0.05), and a trend toward higher platelet counts, as compared to those who tested negative for anticardiolipin antibody. The mean daily prednisone dose at the time of sampling was significantly lower in giant cell arteritis patients with anti-cardiolipin antibodies (p < 0.05); this difference may account for the apparent correlation between anti-cardiolipin antibodies and laboratory markers for inflammation. These data, as well as findings from serial measurements, suggest that anti-cardiolipin antibodies are present early in the course of giant cell arteritis and disappear within a few weeks of initiation of corticosteroid therapy in a dose of more than 25 mg prednisone per day. In this study, only one patient without anticardiolipin antibodies developed a cerebrovascular accident. Positive tests for anti-cardiolipin antibody or anti-beta 2 glycoprotein I antibody in a patient with polymyalgia rheumatica suggest a diagnosis of concomitant giant cell arteritis, which is usually symptomatic.

Aged↗
PubMed1984

Polymyalgia rheumatica and giant cell arteritis.

Polymyalgia rheumatica is a relatively common syndrome of older patients, mostly white, manifested by aching and morning stiffness of the pelvic and shoulder girdles and accompanied by a rapid erythrocyte sedimentation rate. The symptoms are due to a synovitis, which is mild, nondestructive and very responsive to low-dose steroid treatment, which may need to be continued for several years. Temporal arteritis, which may accompany polymyalgia, can present as headache, loss of vision, diplopia or jaw claudication. To suppress arterial inflammation and preserve vision, administration of prednisone, 50 mg a day for one month, is recommended, following which the dose is tapered according to the symptoms, not the sedimentation rate.

Female↗
PubMed2006

Polymyalgia rheumatica and giant cell arteritis.

Polymyalgia rheumatica and giant cell arteritis are the commonest inflammatory rheumatic conditions seen in the elderly. This review focuses on the diagnostic processes and complications of disease and treatment; and the safe management of these conditions with careful consideration of balance between benefits and long-term risks of glucocorticosteroid therapy.

Aged↗
PubMed1997

Giant cell arteritis and polymyalgia rheumatica.

Giant cell arteritis and polymyalgia rheumatica are linked conditions that frequently occur in the same patient. They are more common in northern Europe and persons of European descent than in other populations. Recent investigations have begun to provide information about the pathogenesis of both syndromes. Both respond to corticosteroids but at different dose levels. Although a number of vascular complications may occur, the outlook is excellent.

Europe↗
PubMed1988

Late-onset rheumatoid arthritis vs polymyalgia rheumatica: making the diagnosis.

Differentiating polymyalgia rheumatica from the onset of rheumatoid arthritis in the elderly has been the cause of much unnecessary confusion. Differential diagnosis of these disorders can be straightforward. A strategy is outlined, comprising a complete history, attention to clinical signs, and appropriate use of laboratory diagnostics. The clinical picture of each disorder is discussed, as are common obstacles to diagnosis.

Age Factors↗