Fortnightly review: Polymyalgia rheumatica and temporal arteritis: diagnosis and management

Swannell, A J

doi:10.1136/bmj.314.7090.1329

Cited by 50 publications

(99 citation statements)

References 17 publications

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“…The incidence therefore varies between 10-50 cases/100,000 of the population aged over 50. 3 The number of persons at risk is expected to double in the next 25 years as the average age of the population increases. 14 The cause of PMR is unknown as is the relationship between PMR and GCA.…”

Section: Prevalence and Aetiologymentioning

confidence: 99%

“…A rapid response to steroids is an important diagnostic pointer. 1,3 In GCA, arteries may be thickened, tender and nodular with pulsation being absent or reduced. 13 Temporal artery biopsy is not an investigation with a high sensitivity and where GCA is suspected, despite a negative biopsy, steroid treatment should be started.…”

Section: Diagnostic Parametersmentioning

confidence: 99%

“…2 However, it has been argued that PMR and TA are clinical syndromes that from part of the spectrum of GCA and so different manifestations of the same disease process. 3,4 One author suggests that a generic term of 'polymyalgia arteritica' should be used where the 'relatively benign' PMR may later progress to GCA with its 'multi-system pathological process' including TA. 5 In GCA a syndrome of systemic inflammation accompanies the vascular manifestations.…”

mentioning

confidence: 99%

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Polymyalgia rheumatica and its links with giant cell arteritis

Charlton

2008

Clinical Medicine

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-Polymyalgia rheumatica (PMR) was defined in 1957 and is linked with giant cell arteritis (GCA) in approximately 25% of cases. The peak incidence is between 60 and 75 years old and is increasing with the ageing population. Polymyalgia rheumatica is a clinical diagnosis without a 'gold standard' serological or histological test and there are other conditions that may mimic PMR. Treatment with a dose of 10-20 mg daily of prednisolone is suggested or 40-60 mg daily if GCA is also suspected. There are no absolute guidelines to the dose or its duration. The rate of reduction should be adjusted depending on the individual's response. Where temporal arteritis is suspected, this manifestation of GCA is a treatable medical emergency to prevent possible blindness, and steroids should be commenced immediately. There remain many unknowns in the cause, diagnosis and treatment of PMR and its overlap with GCA, and it is an ongoing challenge requiring further research.

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Section: Prevalence and Aetiologymentioning

confidence: 99%

Section: Diagnostic Parametersmentioning

confidence: 99%

mentioning

confidence: 99%

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Polymyalgia rheumatica and its links with giant cell arteritis

Charlton

2008

Clinical Medicine

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“…A rapid resolution of symptoms with steroid therapy is considered a diagnostic hallmark (15). Lack of response may indicate an incorrect diagnosis (16).…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes, quality of life, and diagnostic uncertainty in the first year of polymyalgia rheumatica

Hutchings¹,

Hollywood²,

Lamping³

et al. 2007

Arthritis & Rheumatism

125

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Objective. To evaluate the impact of polymyalgia rheumatica (PMR) on clinical outcomes and quality of life (QOL); the relationship between laboratory measures and clinical outcomes, and changes in QOL; and agreement between rheumatologists in confirming the initial diagnosis. Methods. We conducted a prospective study of 129 participants in 8 hospitals in England who met a modified version of the Jones and Hazleman criteria and had not started steroid therapy. The main outcome measures were response to steroids after 3 weeks (minimum 50% improvement in proximal pain, morning stiffness <30 minutes, acute-phase response not elevated), relapses, QOL as measured by the Short Form 36 and Health Assessment Questionnaire, and diagnosis reassessment at 1 year. Results. At 3 weeks, 55% of participants failed to meet our definition of a complete response to steroid therapy. Both physical and mental QOL at presentation were substantially lower than general population norms and improved by 12.6 (95% confidence interval [95% CI] 10.8, 14.4) and 11.2 (95% CI 8.5, 13.8) points, respectively, at 1 year. Proximal pain and longer morning stiffness were significantly associated with lower physical QOL during followup, whereas erythrocyte sedimentation rate was most strongly associated with lower mental QOL during followup. There was moderate agreement between clinicians in confirming the PMR diagnosis (kappa coefficients 0.49 -0.65). Conclusion. PMR is a heterogeneous disease with a major impact on QOL. Ongoing monitoring should include disease activity based on symptoms, emergence of alternative diagnoses, and early referral of atypical and severe cases.

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“…Steroids can be administered for as many as 10 to 14 days before a temporal artery biopsy, without affecting the biopsy results [49]. Oral prednisone has been the mainstay of treatment and the use of intravenous steroids has conflicting data to support the use, but it may be reasonable in severe cases [50][51][52]. The goal of maintenance prednisone therapy is to prevent recurrent ischemic events and the patient's clinical response, and the ESR and C-reactive protein should be followed.…”

Section: Temporal (Giant Cell) Arteritismentioning

confidence: 99%