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PubMed1975

Visual complications of polymyalgia rheumatica (polymyalgia arteritica).

Four case histories are reported in which patients with polymyalgia rheumatica (polymyalgia arteritic) developed evidence of cranial arteritis (in one case two years and in one six months) following withdrawal of steroid therapy after apparent cure. In three cases partial or complete loss of sight has resulted. Steroid therapy should not only be introduced rapidly at appropriate dosage levels as soon as the diagnosis is made but should not be reduced or discontinued prematurely.

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PubMed1990

Polymyalgia rheumatica.

Polymyalgia rheumatica is a syndrome that occurs in the elderly and is characterized by pain and stiffness involving the neck, the shoulder girdle, and the hip girdle. The aching should be present for greater than one month. Polymyalgia rheumatica may be more common than reported. The etiology remains unknown. There is generally little found pathologically in this disease. The physical examination is often not impressive. Synovitis may be a main contributing factor to many of the symptoms seen in patients with polymyalgia rheumatica. Symptoms often do not correlate with physical findings. Polymyalgia rheumatica must be differentiated from many conditions since the diagnosis remains entirely clinical. Osteoarthritis, flu syndromes, inflammatory myopathies, fibromyalgia, and depression all have features that may mimic polymyalgia rheumatica. Malignancies and infections may also be difficult to separate from polymyalgia rheumatica. Polymyalgia rheumatica may also be extremely difficult to differentiate from seronegative rheumatoid arthritis in patients older than 50 years. Although some patients with polymyalgia rheumatica have underlying giant cell arteritis, the majority apparently do not. The distinction between polymyalgia rheumatica and giant cell arteritis cannot be made on the basis of laboratory studies and relies solely on clinical symptoms and physical findings. Although nonsteroidal antiinflammatory medications may control symptoms in patients with mild disease, most patients with polymyalgia rheumatica require low-dose corticosteroids. The tapering schedule for the corticosteroids is contingent upon the response of symptoms and laboratory parameters. Polymyalgia rheumatica usually follows a benign course with almost complete response to an adequate treatment program. Recently, there have been several studies suggesting that the course of polymyalgia rheumatica may not be as short and simple as once proposed. Nevertheless, many patients may be completely weaned from corticosteroids. Other agents have been used in this disease, but for the most part their use remains somewhat controversial. Patients must be monitored carefully. Most patients do well, and treatment is effective.

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PubMed2006

[Polymyalgia rheumatica].

Polymyalgia rheumatica is a disorder that affects people over 50 years of age. The etiology of the disease has not been hitherto clarified exactly. Its incidence among people over 50 is in the range of 0.1-0.5%. The incidence rate peaks in the age group of 60-70 years. It is also found in younger people, but far less frequently. The diagnosis is based primarily on locomotor complains--namely on pronounced pain, morning stiffness of the shoulder girdle, pelvic girdle and neck. Complaints relating to the arms and legs (such as muscular weakness, oedema, tendonitis etc.) are also observed, however, in one third of the cases. The diagnostic criteria are defined empirically. Polymyalgia rheumatica was formerly considered to be a form of elderly onset rheumatoid arthritis. The progressive erosion process is absent in the case of polymyalgia rheumatica unlike in the case of rheumatoid arthritis. Numerous factors are known, which point to a link between polymyalgia rheumatica and giant cell vasculitis, arthritis, but the precise nature of this relationship remains unknown. Both conditions affect the same age group in the general population and they are even found--not infrequently--in the same patient. Polymyalgia rheumatica can be found in 40% of the patients suffering from arthritis while the histological examination detected mild vasculitis in approximately 10% of the patients suffering for "isolated" polymyalgia rheumatica. The response to be given to the acute phase is similar in both disorders. Scandinavian authors consider polymyalgia rheumatica as the appearance of generalised arthritis. Arthroscopic, nuclear magnetic resonance imaging as well as isotopic studies show unequivocally, that in the background of the osteo-muscular symptoms, complaints, inflammation is to be found partly of the joints but primarily that of the periarticular synovial structures. The above mentioned--dominant--proximal symptoms can often mask the distal locomotor disorders (pitting oedema of the hands and feet, tendonitis, tendosynovitis, carpal tunnel syndrome). The disorder may be accompanied by atypical generalised symptoms (loss of appetite, weight loss, fever, fatigue). An excellent indicators of the acute phase reactions are erythrocyte sedimentation rate, C-reactive protein and interleukin-6. These are suitable for monitoring the effectiveness of the therapy, for indicating a relapse/recurrence. It should be noted, that polymyalgia rheumatica may also be present if the erythrocyte sedimentation rate and C-reactive protein values are low. This disorder is also characterised by fast and effective response to corticosteroid, which should be administered for 1-2 years. In some individual cases a different dosage regime may be necessary: steroid administered in low dosage over a longer period of time. Administration of methotrexate and anti-tumor necrotic factor-alpha may also be considered as alternative or adjuvant therapy for lowering the quantity of corticosteroid. Further multicenter, double blind studies should, however, be performed on large number of patients in this regard.

Adrenal Cortex Hormones↗

PubMed1991

Relation of giant cell arteritis to polymyalgia rheumatica.

Polymyalgia rheumatica and temporal arteritis appear to be separate syndromes rather than two manifestations of an underlying giant cell arteritis. Polymyalgia rheumatica is a synovitis that may be persistent or recurrent, while temporal arteritis is almost always a single episode; documented recurrences are rare. The two syndromes frequently occur in the same patient although not necessarily at the same time and they may be separated by a long interval. In some patients with polymyalgia rheumatica, giant cell arteritis is found on biopsy of an asymptomatic temporal artery. The frequency of this concurrence is variable in different populations. It is high in Scandinavia, low in Israel and intermediate between these extremes in other populations that have been studied.

Giant Cell Arteritis↗

PubMed1988

The spectrum of polymyalgia rheumatica.

Polymyalgia rheumatica and temporal arteritis are common syndromes of unknown cause that afflict older patients, the great majority of whom are white. Polymyalgia, which is seen more frequently, is a benign synovitis and can be differentiated from rheumatoid arthritis by the distribution of inflamed joints and by its rapid and complete response to small doses of prednisone. Temporal or giant cell arteritis occurs in approximately 20 per cent of patients with polymyalgia rheumatica and may present with either localized or systemic symptoms. Once the diagnosis is confirmed by temporal artery biopsy, patients should be treated with a large dose of prednisone for at least 1 month. The erythrocyte sedimentation rate is a useful test in suspecting the diagnosis initially, but is a poor gauge to tapering the steroid dose.

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PubMed1988

Locked jaw in polymyalgia rheumatica.

Polymyalgia rheumatica is a common disease affecting the elderly population. Symptoms and signs are often nonspecific, including pain and stiffness in the proximal muscles, anorexia, fatigue, depression, weight loss, fever and temporal headaches. We would like to report a case of polymyalgia rheumatica with locked jaw, a feature yet unrecorded.

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PubMed1997

Diagnostic dilemmas in polymyalgia rheumatica.

Polymyalgia rheumatica is a clinical syndrome of proximal muscle pain in older patients that often presents a diagnostic challenge because of the large differential diagnosis, lack of definitive diagnostic criteria, and relatively frequent "atypical" clinical findings, such as peripheral synovitis, distal extremity pain, normal erythrocyte sedimentation rate, and mild weakness. Despite an extensive differential diagnosis that includes endocarditis and steroid-responsive malignant neoplasms, routine laboratory testing should be limited, and a low-dose corticosteroid trial is useful as the final step in the evaluation. The clinical overlap with seronegative rheumatoid arthritis is striking, suggesting that these diagnoses may represent different presentations of a similar disease process. While concurrent asymptomatic temporal arteritis is common, there are no data to support obtaining a temporal artery biopsy in patients with pure polymyalgia rheumatica symptoms.

Diagnosis, Differential↗

PubMed1999

Current therapy of polymyalgia rheumatica.

Polymyalgia rheumatica is characterized by muscular pain and stiffness developing almost exclusively in individuals older than 50 years. Most likely, survival is similar to that of the general population, and perceivably neither malignant diseases nor cardiovascular disorders occurs more frequently than expected. Thus, the main aim of treatment is symptomatic relief and the benefit of such interventions should always be weighed against the possible risks of drug induced side effects. The review addresses the therapeutic options in polymyalgia rheumatica, and focuses on oral corticosteroids, intramuscular and intravenous methylprednisolone, deflazacort, and methotrexate.

Adrenal Cortex Hormones↗

PubMed1978

Giant cell arteritis-a systemic spectrum including temporal arteritis and polymyalgia rheumatica.

Polymyalgia rheumatica and giant cell arteritis are closely associated disorders that may pose serious threats to the elderly. While the etiological factors remain unknown, these clinical entities may represent different expressions of a common disorder. Recent evidence suggests that autoimmunological involvement of the internal elastic lamina of the large and medium-sized arteries might play an importent role in pathogenesis. Genetic and environmental factors may also contribute. Polymyalgia rheumatica and giant cell arteritis have subtle and protean manifestations and formes frustes occur, contributing to delays in diagnosis unless the clinician holds a high index of suspicion while treating the elderly. The sequelae, including generalized disability, blindness, myocardial and cerebrovascular catastrophies can probably be avoided by timely and prudent use of corticosteroids. These are not uncommon disorders are among the most amenable to treatment of the rheumatological diseases. Family physicians must be diligent in their efforts to diagnose these disorders since early generalized and focal signs and symptoms frequently precede the catastrophic events.

Adrenal Cortex Hormones↗

PubMedDate not supplied

Polymyalgia manifestations in different conditions mimicking polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a generally benign syndrome involving the neck, shoulder, and hip girdles in the elderly. However, none of the clinical and laboratory findings are specific for this syndrome. Different diseases may present with features suggesting PMR. The consideration of other conditions which in some cases resemble PMR is very important, as their therapy and prognosis differ completely from that of PMR. Four patients presenting with typical PMR manifestations, who were finally diagnosed as having conditions very different from PMR, are described. The importance of the differential diagnosis in patients presenting with polymyalgia symptoms is underlined.

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PubMed1991

Epidural lipomatosis as a cause of spinal cord compression in polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a common rheumatologic disorder in older individuals that usually requires chronic, low dose corticosteroid therapy for adequate control of symptoms. Epidural lipomatosis is a rare complication of chronic corticosteroid use in which neurologic deficits occur due to extradural fat compression of the spinal cord. The author describes the first reported case of epidural lipomatosis occurring as a complication of corticosteroid therapy in a patient with PMR.

Adrenal Cortex Hormones↗

PubMed1999

[Diagnosis and treatment of polymyalgia rheumatica].

Polymyalgia rheumatica is a clinically defined disorder characterised by inflammatory pain in the neck, back, or shoulder or pelvic girdle muscles in a patient over 50 years of age. Results of laboratory work-up reflect only the inflammatory syndrome. Early diagnosis allows rapid initiation of low-dose corticosteroids, which dramatically improves the symptoms and avoids long, costly and difficult investigations. The cause of the disorder is poorly understood and its relationship to temporal arteritis is sometimes unclear, although the two can usually be distinguished, based on recent findings.

Adrenal Cortex Hormones↗

PubMed1997

Pulmonary fibrosis associated with polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) and exacerbated pulmonary fibrosis presented concurrently in a 69-year-old woman with a 5-year history of idiopathic interstitial pneumonia. The radiographic and histological examinations suggested usual interstitial pneumonia (UIP) as a more likely diagnosis. Corticosteroid therapy resulted in relief of the patient's muscle symptoms and improvement in the functional and radiographical signs of the pulmonary fibrosis. The final diagnosis was pulmonary fibrosis associated with PMR, because PMR is believed to be one of the causes contributing to interstitial lung diseases.

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PubMed2005

Steroid-reversible parkinsonism as presentation of polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is an inflammatory disorder typically affecting elderly people, characterized by pain and stiffness in the neck and in the shoulder and pelvic girdless with prompt clinical response to low doses of corticosteroids. PMR is closely related to giant cell arteritis (GCA), likely sustained by a "subclinical vasculitis". Whereas in GCA both the central and peripheral nervous systems may be involved, only a PMR case of global, steroid-reversible dementia has been hitherto described. We report two elderly patients who abruptly developed, as PMR presenting symptom, an akinetic-rigid parkinsonian syndrome that promptly and completely resolved after corticosteroid treatment.

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PubMed1999

[Polymyalgia rheumatica].

Polymyalgia rheumatica (PMR) is a disease of unknown etiology characterized by severe myalgia and stiffness at shoulder girdle and pelvic girdle muscles and by normal serum creatine kinase levels. Marked elevation of erythrocyte sedimentation rate, acute onset within two weeks, and appearance in the aged are also additional characteristics of PMR. Ten to 50% of PMR patients have a concomitant temporal arteritis (TA)(giant cell arteritis). For the differential diagnoses of PMR, rheumatoid arthritis, polymyositis, fibromyalgia, malignancies, infections and depression should be considered. PMR without TA is treatable successfully with small amount of steroids (15-20 mg/day of prednisolone). For the PMR patients with TA should be treated with large amount of steroids (40-60 mg/day of prednisolone) or steroid pulse therapy.

Anti-Inflammatory Agents↗

PubMed2004

Inflammatory diseases in older adults: polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a common inflammatory disease in adults over age 50, and particularly in women. Teasing apart the diagnosis of PMR from other inflammatory and degenerative diseases is mandatory because there are effective treatments for this reversible condition. Onset of PMR is usually acute, with pain typically beginning in the neck and upper arms, though it can begin in the pelvic girdle. Low grade fever may occur; swelling of the joints is not typical, although swelling of the knees may be present on occasion. There are no specific laboratory or radiographic findings although some consider an elevated sedimentation rate (> 50 mmg/hr) to be essential to diagnosis. Differential diagnoses can be myriad. Treatment, typically with prednisone (occasionally methylprednisolone), requires individualized regimens, particularly during tapering.

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PubMed1976

Polymyalgia rheumatica.

Polymyalgia rheumatica should be considered when a syndrome of constitutional symptoms, especially weight loss, low-grade fever, weakness, wasting proximal muscles, fatigue, malaise and depression, is seen in the elderly. Giant-cell arteritis plays a part later in the course. Thus the need for biopsy of a long segment of the temporal artery to help in determining diagnosis and therapy. An elevated erythrocyte sedimentation rate (ESR) is an important clue. The usual high value is about 80 mm/hour; if it is over 100 mm/hour, giant-cell arteritis should be suspected. Salicylates, indomethacin, phenylbutazone and hydroxychloroquine produce some clinical improvement but do not lower the high ESR; moreover, the patients are prone to experience relapses. Prednisone, however, not only produces clinical improvement but lowers the high ESR. Potassium p-aminobenzoate may be useful in maintaining the remission.

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PubMed1998

Epidemiology and optimal management of polymyalgia rheumatica.

Polymyalgia rheumatica (PMR) is a disease of unknown aetiology that occurs in elderly patients, predominantly affecting the Caucasian population. The disease has a slightly higher prevalence in women than in men. There is ongoing discussion regarding the relationship between PMR and giant cell arteritis; an increasing number of studies indicate that they are closely related. PMR has also been linked with rheumatoid arthritis, myopathy and malignant disease. Oral corticosteroids remain the mainstay of drug therapy for PMR. These drugs usually induce prompt relief of symptoms, and some authors consider this dramatic response to be diagnostic for PMR. However, the ideal initial dosage, the duration of treatment and the optimal tapering schedule are much debated. Other drugs, such as methotrexate and azathioprine, have been suggested as corticosteroid sparing agents. Nonsteroidal anti-inflammatory drugs are generally considered to be unsuitable for the long term treatment of PMR.

Administration, Oral↗