Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

Nielsen, Berit Dalsgaard; Dasgupta, Bhaskar

doi:10.4081/reumatismo.2018.1070

Cited by 3 publications

(5 citation statements)

References 43 publications

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“…Although PMR and GCA overlap with each other, it is still unclear whether GCA represents a separate condition from PMR or whether it is a potential expression of the same disease. The concept of a GCA complex is gradually evolving [18,19].…”

Section: Gca Complexmentioning

confidence: 99%

“…PMR, as a conceptualization of the GCA complex, may be regarded as an early or aborted form of vasculitis, wherein the vascular inflammation stops at the adventitia of the vessel wall. The acute phase of GCA is mainly inflammatory, and chronic stages are characterized by inflammation, degradation, and repair mechanisms jointly resulting in structural changes of the vessel wall, ischemic complications, and aneurysm development [18,19].…”

Section: Gca Complexmentioning

confidence: 99%

“…Subclinical GCA in patients with PMR may be detected using vascular imaging (contributing to another 10%-35%), though this is not typically performed in patients with isolated PMR features. Moreover, no clear prognostic test exists for PMR, and even the gold standard temporal artery biopsy (TAB) for diagnosing GCA is positive in only 39%-87% of cases [18,19].…”

Section: Epidemiologymentioning

confidence: 99%

“…A pronounced inflammatory response at disease onset is often associated with a higher probability of relapses in both GCA and PMR. Assuming that IL-6 blockade would be particularly effective in cases with high levels of systemic inflammation, these patients would possibly benefit most from treatment with IL-6 blockers [9,18,19].…”

Section: Treatmentmentioning

confidence: 99%

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Polymyalgia Rheumatica, an Age-Related Rheumatic Disease

Schmidt¹,

Poór²

2022

OBM Geriatr

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Polymyalgia rheumatica (PMR) is an age-related chronic inflammatory disease with rheumatic features at the fore. In addition to the high-grade systemic inflammation, it is characterized by typical “polymyalgic” musculoskeletal symptoms, including diffuse and severe pain and prolonged morning stiffness of the shoulder girdle, pelvic girdle, and neck. PMR is a member of the so-called giant cell arteritis complex; however, in spite of the marked systemic inflammation in PMR, the local vasculitis process aborts. The pathological background is synovitis, with a predominant inflammation of the extra-articular synovial structures. Synovitis of PMR is mild, transient, and non-erosive. Distal musculoskeletal symptoms are also observed but are more variable and less recognizable than the predominant proximal polymyalgic syndrome. PMR often overlaps with elderly-onset seronegative arthritides, elderly-onset rheumatoid arthritis, late-onset seronegative spondylarthritis, and the RS3PE1 syndrome. Although glucocorticoids are the cornerstone of PMR therapy, considerable hope is attached to tocilizumab, an IL-6 receptor inhibitor.

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Section: Gca Complexmentioning

confidence: 99%

Section: Gca Complexmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

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Polymyalgia Rheumatica, an Age-Related Rheumatic Disease

Schmidt¹,

Poór²

2022

OBM Geriatr

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“…The vast majority of PMR patients are diagnosed and managed in general practice [3][4][5]. Diagnosing PMR can be challenging as many conditions can mimic the disease [6]. The variety of symptoms may lead to hospitalisation to rule out other serious diseases [7].…”

Section: Introductionmentioning

confidence: 99%

The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients

et al. 2021

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Objectives This study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis. Methods Patients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018. Results Over 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p < 0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose. Conclusion A substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients. Trial registration Retrospectively registered.

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Critérios classificatórios para polimialgia reumática

Aguiar

2022

Rev Paul Reumatol

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A polimialgia reumática (PMR) é uma doença inflamatória frequente em indivíduos com mais de 50 anos, e seu diagnóstico é baseado no quadro clínico de dor em cinturas (pélvica e escapular), acompanhado do aumento de provas inflamatórias e de achados radiológicos sugestivos, como a bursite subacromial e trocantérica. A lista de diagnósticos diferenciais para a PMR é grande e vários conjuntos de critérios para o diagnóstico da doença já foram desenvolvidos. Em 2012, o American College of Rheumatology (ACR) e a European League Against Rheumatism (EULAR) desenvolveram critérios provisórios de classificação para PMR, que apresentam sensibilidade 66-68% e especificidade 78-81%. Esses critérios funcionam a partir de um sistema de pontuação que se baseia na presença de manifestações clínicas típicas, na ausência de fator reumatoide e anti-CCP e, quando disponível, na presença de achados ultrassonográficos característicos. Apesar de serem úteis na prática clínica, esses critérios ainda precisam de validação prospectiva e sua acurácia para a diferenciação entre PMR e artrite reumatoide (AR) soronegativa do idoso é baixa. Unitermos: Polimialgia reumática. Classificação. Diagnóstico diferencial. Ultrassonografia. Doença autoimune.

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Perspectives and unmet needs in polymyalgia rheumatica. Providing the fundamental framework for the development of new treatment regimes in polymyalgia rheumatica

Cited by 3 publications

References 43 publications

Polymyalgia Rheumatica, an Age-Related Rheumatic Disease

Polymyalgia Rheumatica, an Age-Related Rheumatic Disease

The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients

Critérios classificatórios para polimialgia reumática

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