Polymyalgia rheumatica

Abstract

Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. Vascular uptake on PET scans is seen in some patients. A dose of 12·5-25·0 mg prednisolone daily or equivalent leads to rapid improvement of symptoms in most patients with isolated disease. However, relapses are common when prednisolone is tapered. Methotrexate might be used in patients who relapse. The effectiveness of biological therapies, such as anti-interleukin 6, in patients with polymyalgia rheumatica that is refractory to glucocorticoids requires further investigation. Most population-based studies indicate that mortality is not increased in patients with isolated disease.

Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study

“…This was also demonstrated by Smeeth et al 10. Genetic associations between specific human leucocyte antigen molecules and GCA have been found,26 although none yet for PMR 27. However, as no major variation has been found in the genetic make-up of people between different regions around the UK, it is unlikely to be the reason for this difference 28.…”

Anarthritic Rheumatoid Arthritis and the Continuing Dilemma of Polymyalgia Rheumatica: Case Report

“…It suggests that most patients with PMR evolve their disease process into SNRA, which in turn can be successfully treated without ever implementing CSs. And yet recent reviews by investigators studying PMR have chosen to ignore this evidence [4,5,6]. Instead, these researchers not only perpetuate traditional concepts of CSs treatment in PMR, but they also speculate on atypical temporal artery biopsy findings in PMR to explain why it not infrequently overlaps with classical biopsy proven GCA.…”

Polymyalgia Rheumatica: A Challenging Diagnosis in Elderly Patients - Case Reports

“…In case 1, only fatigue and vague new onset headache after stroke were present. In general, GCA patients with typical cranial symptoms have a high risk of developing ischemic events 6,7) . However, one study reported that ischemic events had occurred in GCA patients who had no other cranial presentations 8) .…”