Depression and depressive symptoms in patients with polymyalgia rheumatica: discussion points, grey areas and unmet needs emerging from a systematic review of published literature

Abstract

Objectives: In 1979, Bird et al. proposed depression as a diagnostic criterion for polymyalgia rheumatica (PMR). More recently, the significance of depression in PMR patients has been re-proposed, , and some researchers have suggested that PMR may increase the risk of depression. The aim of our article is to evaluate the relationship between PMR and depression. Material and methods: Systematic literature searches were performed on 19 th and 20 th May 2020 based on Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The search was restricted to all studies and case reports with English abstract, published in any language, since 1979 (when depression was first proposed as a diagnostic criterion for PMR) describing the association of PMR with depression. Exclusion criteria were as follows: reviews, conference abstracts, comments, non-original articles; and articles discussing giant cell arteritis (GCA) and PMR when data and observations for the two conditions were not clearly subdivided. Results: The initial search yielded 812 papers, of which 115 duplicates were removed. A total of 697 articles had a first screening and 506 were excluded based on title and abstract reviews; 117 articles underwent full-length scrutiny, and 99 full-text articles were excluded because they did not meet the inclusion and exclusion criteria (reviews and comments = 58; articles with outcome of interest not reported = 34; low-quality articles = 7). At least, 18 articles were included in this review. Conclusions: The review did not find any studies that clarified the prevalence rates of depression in patients with PMR. Furthermore, the studies reviewed did not offer any clarity as to whether patients suffered from just depressive symptoms or clinical depression, and that accepted diagnostic criteria for depression had not been employed, indicating that a robust method for diagnosing depression had not been employed. Collaboration of different professionals should be improved through shared guidelines.

Feasibility and usefulness of a fast-track clinic for patients suspected of polymyalgia rheumatica: notes for a work schedule through a narrative review of published literature

“…The impaired psychical domain inevitably alters patients’ QoL in association with other potential co-existing symptoms such as sleep disturbances and most notably stiffness, which is closely related to function, often preventing patients from carrying out their daily activities [ 17 – 19 ]. Nevertheless, according to a recent systematic review, grey areas are still present in the assessment of depression and depressive symptoms in patients with PMR [ 44 ].…”

The Role of Tumor Necrosis Factor Alpha Antagonists (Anti TNF-α) in Personalized Treatment of Patients with Isolated Polymyalgia Rheumatica (PMR): Past and Possible Future Scenarios

“…Detectable plasma TNF-α might not represent the concentration of cytokine locally produced at the site of inflammation. As already highlighted, a study documented increased levels of some proinflammatory cytokines (TNF-α among these) in the interstitium of affected muscles in patients with PMR [ 27 ].…”

“…Long-term GC therapy can induce many adverse events: diabetes mellitus, hypertension, cataract and osteoporosis are among the most studied ones [ 24 , 25 , 26 ]. On the contrary, all their emotional and psychological consequences are barely explored, yet they influence the relationship between PMR patient and rheumatologist [ 27 , 28 ].…”

Prevalence and identification of neuropsychiatric symptoms in systemic autoimmune rheumatic diseases: an international mixed methods study

“…There are also gaps in the SARD literature regarding a wider range of potential NP symptoms, such as psychiatric, neuro-ophthalmological, auditory-vestibular and peripheral nervous system symptoms. Aside from SLE, where neuropsychiatric lupus (NPSLE) has been more widely researched [ 1 , 6 , 7 ], research on a range of NP symptoms in several SARDs is very limited, particularly UCTD and PMR [ 4 ]. Gaps in the literature are also apparent concerning the identification/non-identification of NP SARD symptoms in clinical practice, with, for example, little on the extent to which clinicians ask SARD patients about NP symptoms.…”