Peripheral Musculoskeletal Manifestations in Polymyalgia Rheumatica

Abstract

Fifty-one percent of the patients with PMR presented distal musculoskeletal manifestations, with peripheral synovitis being the most frequent one. Patients with PMR with peripheral synovitis did not represent a high-risk subgroup with more severe disease. Seven patients who developed criteria for seronegative RA within the first year of follow up had presented statistically significant persistent synovitis compared with those who continued as PMR and also showed a smaller initial decrease in mean ESR after steroid treatment was initiated. The absence of persistent arthritis and the benign course of the arthritis permit the distinction of PMR from other inflammatory arthropathies.

Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica

“…The prognostic value of peripheral arthritis was investigated by seven studies (n=645, LoB 2–6/8) 24 35 38 45 46 55 57. The presence of peripheral arthritis was associated with a higher risk of relapse according to one study (n=177, LoB 5/8),55 whereas three studies (n=207, LoB 5–6/8) did not confirm this observation 24 35 55…”

2015 Recommendations for the Management of Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative

“…Baseline factors that were associated with a higher relapse rate and/or prolonged therapy in PMR studies were: female sex (38,47), high erythrocyte sedimentation rate (ESR) (.40 mm/hour) (47)(48)(49)(50)(51)53) and peripheral inflammatory arthritis (54). A number of studies, however, failed to demonstrate association between these factors and relapse (48)(49)(50)(51)54,(67)(68)(69)(70)(71)(72)(73)(74)(75)(76)(77)(78). 4 Use the minimum effective dose out of a range of 12.5-25 mg prednisone equivalent daily: a high risk of relapse/prolonged therapy favors a higher dose, while a high risk of side effects favors a lower dose.…”

Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica

“…Carpal tunnel syndrome in PMR has also been noted. 15 Ceccato et al 16 showed that 39% of patients who had peripheral synovitis presented with pitting edema (5%), carpal tunnel syndrome (5%), and distal tenosynovitis (1.3%). In our 41 patients with PMR, four patients (9.8%) developed distal arthritis and 50% of distal arthritis was knee arthritis.…”