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PubMedDate not supplied

Abnormalities of peripheral blood T lymphocyte subsets in polymyalgia rheumatica.

The T lymphocyte subsets were studied by monoclonal antibodies in the blood of eight patients with polymyalgia rheumatica. The percentages of circulating T cells (OKT3+) were lower when compared with normal controls (p less than 0.02), as were the proportions of suppressor/cytotoxic (OKT8+) T cells (p less than 0.001), whereas the proportions of helper/inducer (OKT4+) T lymphocytes were not changed. Consequently, the OKT4:OKT8 ratio was higher in patients with polymyalgia rheumatica than in controls (p less than 0.001). On the contrary, circulating B cells were not altered. The decrease in peripheral blood OKT3+ and OKT8+ lymphocyte subsets suggests that there is an impairment of cell-mediated immunity in polymyalgia rheumatica.

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PubMed2000

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.

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PubMed1977

Association of polymyalgia rheumatica and giant-cell arteritis with HLA-B8.

Histocompatibility antigens were determined in 30 patients with temporal arteritis, 27 patients with polymyalgia rheumatica, and 216 normal blood donors. HLA-B8 was significantly more common in patients with polymyalgia rheumatica (59%) and temporal arteritis (50%) than in the controls (27%). The findings of HLA-A10 in 26% of the patients with polymyalgia rheumatica compared with only 10% of the controls may be associated with the suggested immunological pathogenesis of the condition.

Female↗
PubMed1975

Lymphocyte proliferation to artery antigen as a positive diagnostic test in polymyalgia rheumatica.

The transformation response of peripheral blood lymphocytes in vitro to human arterial and muscle antigen has been studied in patients with polymyalgia rheumatica, polymyositis, rheumatoid arthritis, and polyarteritis, and polyarteritis nodosa and in unrelated controls. Lymphocytes from patients with polymyalgia rheumatica showed transformation responses significantly higher to artery antigen than those in the other disease and control groups. The highest responses were found in patients with evidence of the most active clinical disease at the time of testing. It is suggested that the transformation response to arterial antigen might aid the diagnosis of polymyalgia rheumatica.

Adult↗
PubMed1982

Polymyalgia rheumatica with diffuse cerebral disease responding rapidly to steroid therapy.

A 58-year-old woman presented with the classical features of polymyalgia rheumatica. She also had a global dementia; CT scan and EEG showed diffuse cerebral disease. After steroid treatment, the polymyalgia rheumatica and dementia rapidly resolved and the CT scan and EEG became normal. The inter-relationships of the giant cell arteritides are discussed in the light of this report of the association of polymyalgia rheumatica and steroid-responsive diffuse cerebral disease.

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PubMed1984

[Role of dapsone in the treatment of Horton's disease and polymyalgia rheumatica].

The authors report 8 cases of Horton's disease and/or polymyalgia rheumatica treated with prednisone with an initially favourable result. However, the disease progressed despite relatively high dose steroid therapy, complications of which contraindicated increasing the dosage and even necessitated rapid withdrawal of steroids. The association of dapsone 100 mg/day orally had a rapid favourable effect in all 8 cases. However this treatment was well tolerated in only 3 patients and could only be continued in 4 out of the 8 cases. Manifestations of intolerance (methemoglobinaemia) rapidly regressed after withdrawal of dapsone but this was followed by another exacerbation of the disease, resulting in a therapeutic impasse. Despite the incidence of these iatrogenic complications, dapsone would appear to provide a therapeutic option in patients with Horton's disease and/or polymyalgia rheumatica resistant to high dose steroid therapy or in whom complications of steroid therapy impose a reduction in dosage or complete withdrawal of the drug.

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PubMed1999

New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography.

OBJECTIVE: To study the possible contribution of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the diagnosis of giant cell arteritis and polymyalgia rheumatica. METHODS: A consecutive case series consisting of five patients with polymyalgia rheumatica, six patients with temporal arteritis and 23 age-matched patients with other inflammatory conditions were evaluated with FDG-PET. Studies were performed before therapy with steroids was started. RESULTS: A total of 4/6 patients with giant cell arteritis and 4/5 patients with polymyalgia had increased FDG uptake in their thoracic vessels, compared to 1/23 controls (P < 0.001). Increased vascular FDG uptake in the upper legs was seen in 8/11 patients with giant cell arteritis or polymyalgia compared to 8/23 control patients (P < 0.05), and in the lower legs in 6/11 patients compared to 6/23 controls (P = not significant). CONCLUSIONS: FDG-PET scan is the first non-invasive technique which may indicate large-vessel vasculitis and which can show its extension throughout the body. It strongly suggests that polymyalgia rheumatica is a form of vasculitis.

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PubMed2000

[Myelodysplastic syndrome associated with polymyalgia rheumatica].

A 69-year-old man was referred to us because of severe pain in both girdles. A diagnosis of polymyalgia rheumatica was made, and low-dose prednisolone therapy (20 mg/d) was started. The patient's muscle pain disappeared after 3 weeks. After 5 months of therapy, pancytopenia became prominent. A marrow aspirate smear showed hypercellularity, trilineage dysplasia, and 7% blasts. The clinical diagnosis was myelodysplastic syndrome, subtype refractory anemia with excess of blasts. In elderly patients presenting with polymyalgia rheumatica, an underlying hematologic malignancy should always be looked for when the disease demonstrates clinical signs inconsistent with typical polymyalgia rheumatica.

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PubMed2006

[Polymyalgia rheumatica and giant-cell temporal arteritis].

The article is dedicated to the contemporary concept of the prevalence, etiology, and pathogenesis of polymyalgia rheumatica and Horton's disease. The author analyzes the features of the pain syndrome, arthritis, fever, and other manifestations of the disease. Taking into consideration the fact that polymyalgia rheumatica and Horton's disease are usually revealed too late, the author pays special attention to their diagnostics and differential diagnostics. An increased ESR is a feature of this disease. Polymyalgia rheumatica is treated with prednisolone. The stages of glucocorticoid therapy, the rules of adjustment and lowering prednisolone doses, combined therapy with glucocorticoids and cytostatics, the effectiveness of therapy, and the prognoses are described in detail.

Anti-Inflammatory Agents↗
PubMedDate not supplied

Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis.

OBJECTIVE: To report on several patients with subacute bacterial endocarditis who were initially presumed, incorrectly, to have polymyalgia rheumatica or giant cell arteritis. METHODS: We report 3 cases of subacute streptococcal endocarditis mimicking giant cell arteritis in 2 cases and polymyalgia rheumatica in one. We reviewed the literature through Medline search of French and English-language articles published between 1966 and 2005 and found 5 similar cases. RESULTS: Shoulder and/or pelvic girdle pain was associated with neck or back pain in all patients. Scalp tenderness, bilateral jaw pain, amaurosis fugax were present in 2 patients. One patient had no fever. Two patients were treated with corticosteroids with initial good clinical response in one. Appropriate antibiotic therapy resulted in the rapid disappearance of rheumatic complaints in 2 patients and achieved a definitive cure of endocarditis in all cases. CONCLUSION: Rheumatologic symptoms may hinder the correct diagnosis of infective endocarditis in patients who present with a clinical picture suggesting polymyalgia rheumatica or giant cell arteritis. In such cases, blood cultures should be systematically drawn.

Adrenal Cortex Hormones↗
PubMed2002

[Effect of stressful life events on clinical development of temporal arteritis and/or polymyalgia rheumatica].

OBJECTIVES: To test the hypothesis of an epidemiological relationship between stressful events and the date of emergence of temporal arteritis and/or polymyalgia rheumatica. METHODS: Thirteen patients identified with anatomo-clinical criteria and whose mental state permitted prolonged questioning where included in the survey. A list of 65 events, covering the 2-year period preceding the onset of temporal arteritis and/or polymyalgia rheumatica, was used. Each event was assessed using an emotional scale with positive (1 to 10) or negative scores (-1 to -10). Zero corresponded to an event without impact. An event score was drawn-up for each patient. The results were compared with those of a control group of 26 paired (age and gender) controls, 2 controls for each patient were included. RESULTS: In the group of patients, 12/13 (92.3%) had suffered from negative events 2 years before diagnosis of their disease, with a total of 35 negative events and a score of -271. In the control group, only 10/26 (38.8%) had suffered from negative events with a total of 21 negative events and a score of -132. The comparison (chi 2 test) of the total of recent negative events (2 years before diagnosis) for both groups, i.e., 35/112 versus 21/232, revealed a highly significant difference (chi 2 = 27.3; p < 0.00001). Conversely, there was no significant difference between the two groups regarding the total events having occurred throughout their lifetime. CONCLUSION: This result suggests the influence of stressful events in the clinical emergence of temporal arteritis and/or polymyalgia rheumatica.

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PubMed1990

Rarity of synovitis in polymyalgia rheumatica.

The joints of 56 patients with polymyalgia rheumatica were examined for evidence of inflammatory synovitis. x Rays, isotope scans, and thermography supplemented clinical examination. Control sternoclavicular joints were examined at necropsy. Peripheral and axial synovitis were uncommon and the results contrast with the findings of several recent studies.

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PubMed1979

Polymyalgia rheumatica begins at 40.

Three cases of polymyalgia rheumatica with onset under age 50 are described. Most large series of patients with this entity contain a few examples of onset below age 50. This diagnosis should be made with confidence in younger patients with typical symptoms and laboratory findings, and showing complete suppressions of disease activity with relatively small daily doses (20 mg or less) of corticosteroids.

Adrenal Cortex Hormones↗
PubMed2000

Polymyalgia rheumatica and temporal arteritis: a case presentation.

Polymyalgia rheumatica (PMA) and temporal arteritis (TA) are common clinical syndromes that affect the elderly population. Both syndromes may include similar constitutional complaints, an increase in acute phase reactants, a rapid response to corticosteroids, and the presence of anteritis giant cells upon temporal artery biopsy. Differential diagnosis is one of exclusion. A case presentation is included to assist practitioners in recognizing presenting symptoms, identifying diagnostic testing, and proceeding with appropriate therapy and follow-up.

Adrenal Cortex Hormones↗
PubMed1986

Temporal arteritis after normalization of erythrocyte sedimentation rate in polymyalgia rheumatica.

We describe a 72-year-old woman with classic presentation of polymyalgia rheumatica and an elevated erythrocyte sedimentation rate. After treatment with low-dose corticosteroids and normalization of the sedimentation rate, hematocrit, and serum alkaline phosphatase, she developed symptoms and biopsy proved temporal arteritis. In patients with polymyalgia rheumatica and an initially elevated sedimentation rate, normalization of the sedimentation rate with corticosteroid therapy does not exclude the need for temporal artery biopsy if the symptoms warrant it.

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PubMed1983

Immunoglobulin (Gm) allotype frequencies in patients with giant bell arteritis and polymyalgia rheumatica.

Fifty-five Caucasoid patients with polymyalgia rheumatica (PMR) or giant cell arteritis (GCA) were immunoglobulin (Gm) allotyped for this study. Forty-four of these patients had been previously HLA-A,B,C and DR locus allotyped. The incidence of the immunoglobulin allotypic marker Glm(2) was significantly increased in the GCA group (50.00% v. controls 18.75%, P equal less than 0.01). There was a similar but insignificant rise of this Gm marker in the PMR group (27.24% v. 18.75%, NS). The increase in Glm(2) in the GCA group was not accompanied by a corresponding rise in the number of people homozygous for Glm(2), i.e., all the increase could be attributed to patients with the Glm(1,2,3,):G3m(5,10,21)phenotype.

Giant Cell Arteritis↗
PubMed1987

Lymphoreticular malignancy and monoclonal gammopathy presenting as polymyalgia rheumatica.

Five patients presenting with polymyalgia rheumatica-like symptoms were found to have a monoclonal gammopathy. In addition one of these patients had acute myeloblastic leukaemia, two had early myeloma and one patient had probable Waldenström's macroglobulinaemia. The association of polymyalgia rheumatica-like symptoms, monoclonal gammopathy and lymphoreticular malignancies is discussed.

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