Long-term follow-up of polymyalgia rheumatica: Evidence for synovitis

Healey, L. A.

doi:10.1016/0049-0172(84)90012-x

Cited by 271 publications

(139 citation statements)

References 10 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…A response to steroid therapy is included in 2 sets of criteria (6,8) and is mentioned in 2 (5,7), but none provides a definition for this response. Findings from this study highlight the ubiquitous nonspecific responses to even 15 mg of prednisolone in patients with an initial PMR diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Initial features vary, e.g., PMR without an elevated erythrocyte sedimentation rate (ESR) (3), and common mimicking conditions can present with the polymyalgic syndrome (4). There is no gold standard test and several diagnostic criteria have been used (5)(6)(7)(8). This may explain the lack of agreement in PMR diagnoses between primary care physicians and rheumatologists (9 -11) and the revision of diagnoses in 5-23% of patients with longterm followup (12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Hutchings¹,

Hollywood²,

Lamping³

et al. 2007

Arthritis & Rheumatism

125

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Patients diagnosed as having either PMR (according to the criteria proposed by Chuang et al [5] and Healey [6]) or CPDD (according to the revised criteria of McCarty [2,7]) at the Rheumatology Division of Hospital Meixoeiro (Vigo, Spain) over a 7-year period (1997)(1998)(1999)(2000)(2001)(2002)(2003) were prospectively followed for at least 12 months. Patients were diagnosed as having definite CPDD if calcium pyrophosphate dihydrate crystals were identified by compensated polarized light microscopy, and if typical radiographic calcifications (chondrocalcinosis) were also observed.…”

Section: Methodsmentioning

confidence: 99%

“…To accurately examine the frequency; characteristic clinical, laboratory, and radiologic features; and outcome of CPDD with predominant proximal involvement, we prospectively followed a series of consecutive patients meeting inclusion criteria for either PMR (5,6) or CPDD (definite or probable disease) (7). We compared the findings observed in our patients with both PMR features and CPDD criteria (PMR/CPDD patients) with those of patients presenting with only PMR features (pure PMR patients) to try to identify the best predictive factors for the diagnosis of CPDD.…”

Section: Introductionmentioning

confidence: 99%

Calcium pyrophosphate deposition disease mimicking polymyalgia rheumatica: A prospective followup study of predictive factors for this condition in patients presenting with polymyalgia symptoms

Pego-Reigosa¹,

Rodríguez-Rodríguez²,

Hurtado-Hernandez³

et al. 2005

Arthritis & Rheumatism

View full text Add to dashboard Cite

Objective. To assess the characteristics of calcium pyrophosphate deposition disease (CPDD) with proximal involvement mimicking polymyalgia rheumatica (PMR), and to identify the best predictive factors for the presence of a clinical pattern of CPDD in patients presenting with polymyalgia symptoms. Methods. Patients diagnosed with either PMR or CPDD at the Rheumatology Division of Hospital Meixoeiro (Vigo, Spain) over a 7-year period (1997-2003) were prospectively followed for at least 12 months. Results. The study group comprised 118 patients with PMR features and 112 patients with CPDD. Eighty-two of the 118 patients with PMR manifestations were diagnosed as having pure PMR, and 36 met the diagnostic criteria for both PMR and CPDD. Patients with CPDD mimicking PMR were older (P ‫؍‬ 0.02) and had peripheral arthritis more frequently (P ‫؍‬ 0.004) than those with pure PMR. Radiologic osteoarthritic changes in the hands and knees, including more advanced radiologic grade of knee osteoarthritis, and tendinous calcifications were more frequent in patients with PMR/CPDD (P < 0.001). The best predictive factors for the occurrence of this atypical pattern of CPDD in a patient presenting with PMR features were the age at diagnosis and the presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis. Conclusion. Involvement of proximal joints may be the clinical presentation of CPDD. CPDD should be included in the spectrum of diseases mimicking PMR. The presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis are clues that may alert the clinician to the presence of CPDD in an elderly patient presenting with PMR manifestations.

show abstract

“…Evidence for synovitis has now accumulated from radioactive scans (6), biopsies (7), arthroscopy (8), and clinical findings. In a series of 246 patients with polymyalgia rheumatica followed at the Mason Clinic over a period of 16 years, clinical manifestations of synovitis were found in 77 (9). Knee effusions and swelling of the wrists, often with carpal tunnel syndrome, were encountered most frequently; small joints of the hands and feet were rarely involved.…”

mentioning

confidence: 99%

Long-term follow-up of polymyalgia rheumatica: Evidence for synovitis

Cited by 271 publications

References 10 publications

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

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

Calcium pyrophosphate deposition disease mimicking polymyalgia rheumatica: A prospective followup study of predictive factors for this condition in patients presenting with polymyalgia symptoms

Polymyalgia rheumatica and the american rheumatism association criteria for rheumatoid arthritis

Contact Info

Product

Resources

About