Musculoskeletal manifestations in polymyalgia rheumatica and temporal arteritis

Abstract

Objective-To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA). Methods-The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations. Results-Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed. Conclusion-The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests diVerent mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression. (Ann Rheum Dis 2001;60:1060-1063 There is controversy as to whether polymyalgia rheumatica (PMR) and temporal arteritis (TA) are expressions of the same disease or are two diVerent, partly overlapping, diseases. PMR is a common syndrome of the elderly characterised by pain and stiVness involving the neck, shoulder and pelvic girdles, generally accompanied by constitutional symptoms and a raised erythrocyte sedimentation rate. The cause of musculoskeletal pain in PMR is not completely understood, but inflammation in proximal joints and periarticular structures is a likely basis for much of the discomfort since, to date, there is little evidence to suggest that the musculoskeletal symptoms are related to underlying vasculitis. Evidence of proximal articular and periarticular synovitis has been demonstrated by scanning, MRI, arthroscopy, and synovial biopsy. 1-3Moreover, an increasing number of reports have underlined the presence of peripheral synovitis and other distal musculoskeletal manifestations in PMR, suggesting that the spectrum of musculoskeletal involvement in this entity is not completely defined and is broader than has often been thought previously. [4][5][6][7][8] The clinical predominance of proximal symptoms in PMR has probably overshadowed...

Clinical characteristics of polymyalgia rheumatica in Japanese patients: evidence of synovitis and extracapsular inflammatory changes by fat suppression magnetic resonance imaging

“…Salvarani et al have proposed that the presence of peripheral synovitis in PMR could constitute a more severe subset because it is associated with a longer duration of steroid therapy and a higher frequency of relapse and recurrence. 22 On the contrary, Ceccato et al 26 and Narvaez et al 24 suggested that PMR patients with peripheral synovitis would not represent a high-risk subgroup with more severe disease, since they found no signifi cant differences in clinical symptoms or laboratory data between patients with and without peripheral synovitis. In our study, a more frequent incidence of extracapsular abnormalities in shoulders was observed in PMR patients having peripheral arthritis (Table 3).…”

“…The frequency of distal musculoskeletal manifestations in PMR is still controversial, ranging from 6% to 60% in previous reports. 1,22,[24][25][26][27] In this study, 26 patients (81%) showed distal musculoskeletal involvement, and peripheral arthritis was the most frequent one (75%) ( Table 1). Several authors reported an association of mono-or asymmetrical oligoarthritis with PMR; 1,22,24 however, we have found that most episodes of peripheral arthritis are presented bilaterally, and polyarthritis is the most common form (Table 2).…”

Giant cell arteritis, polymyalgia rheumatica, and late-onset rheumatoid arthritis: Can they be components of a single disease process in elderly patients?

“…Narváez et al (14) found that 20% of their patients with PMR developed clinically detectable peripheral arthritis either at diagnosis or during the course of the disease, while 11% of the patients with GCA (8/73) developed peripheral arthritis. Peripheral arthritis in these patients was associated only with the presence of PMR.…”

Polymyalgia Rheumatica Relapse Presenting with Peripheral Pitting Edema

“…Of 90 patients diagnosed with isolated PMR in a rheumatology department in Barcelona, 18 had peripheral distal extremity synovitis and 1 patient had swelling with pitting edema [2] . In all cases, these manifestations occurred in conjunction with active PMR.…”