The process from symptom onset to rheumatology clinic in polymyalgia rheumatica

Dalkılıç, Ediz; Tufan, Ayşe Nur; Hafızoğlu, Emre; Hafizoğlu, Merve; Tufan, Fatih; Oksuz, Ferhat; Pehlıvan, Yavuz; Yurtkuran, Mustafa

doi:10.1007/s00296-014-3034-y

Cited by 18 publications

(15 citation statements)

References 12 publications

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“…In PMR patients, the presence of systemic manifestations strongly favors their hospitalization [ 16 , 17 ]. We cannot rule out that some patients with systemic manifestations have been referred to another hospital and not to our ambulatory clinic.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of polymyalgia rheumatica in primary health care: favoring and confounding factors – a cohort study

Manzo¹,

Natale²,

Traini³

2018

Reumatologia

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ObjectivesTo evaluate in a primary care setting the favoring and confounding factors for the diagnosis of polymyalgia rheumatica (PMR).Material and methodsAmong 303 patients consecutively referred by their general practitioners (GPs) to our rheumatologic outpatient clinic, we identified three groups: group A – patients with confirmed diagnosis of PMR, group B – patients with unconfirmed diagnosis, group C – patients with unrecognized PMR. All the diagnostic confounding and favoring factors were discussed with GPs using an e-mail questionnaire. Participation in rheumatology training courses represented the final question. The collected data were statistically assessed in a blind way. In Fisher’s exact test and ANOVA test, a p-value was significant if < 0.05. The study was carried out in compliance with the Helsinki Declaration and approved by the Ethics Committee of Mariano Lauro Hospital. Every patient signed an informed consent form at the time of the first visit.ResultsAll patients were Caucasian; 24.1% were male; mean age was 72.3 ±8.6 years (min. – 51, max. – 94). There were 41 patients in group A, 93 in group B and 169 in group C. The percentage of misdiagnoses was very high (87.1%): among 134 patients diagnosed with PMR by their GPs (group A + group B) confirmation was made in 41, and in 169 unrecognized PMR was found. Participation in training courses was very significant compared to the diagnostic accuracy (p < 0.0001 in χ2 test) and to the diagnosis timing (24.3 days ±12.5 vs. 42.9 ±15.5 with p-value < 0.05 in the ANOVA test). When the percentages were assessed according to participation, an inadequate evaluation of some clinical manifestations favored over-diagnosis among the trained GPs.ConclusionsThe level of diagnostic accuracy for PMR must be improved in primary care. Participation in rheumatology training courses can be an important step.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of polymyalgia rheumatica in primary health care: favoring and confounding factors – a cohort study

Manzo¹,

Natale²,

Traini³

2018

Reumatologia

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“…A recent study reported that the interval between the onset and diagnosis was 13±13 months 2) . Because constitutional symptoms, such as general weakness, fever, weight loss, and high APR levels, are frequently observed in PMR, infection and concomitant cancer should also be considered 2) . In clinical practice, PMR is commonly misdiagnosed as other diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Extracapsular inflammatory changes outside the joint cavity are common in PMR and can often be confused with a septic joint 14) . Dalkılıç et al 2) reported that 30% of patients with PMR were given antibiotics before the correct diagnosis was made. The lack of awareness of PMR among physicians and the difficulty of differential diagnosis between PMR and septic shoulders may lead to unnecessary surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical features of PMR are similar to those of common shoulder diseases, such as frozen shoulder, rotator cuff tear with bursitis, and acute calcific tendinitis. Because of a significant increase in acutephase reactants (APR) and imaging findings suggesting infection, PMR may be confused with septic arthritis 2) . Giant-cell arteritis (GCA) is an inflammatory vasculitis that typically occurs in medium and large arteries and may cause ischemic events 1) .…”

Section: Introductionmentioning

confidence: 99%

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

Kim

2017

Ann Geriatr Med Res

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“…It was illustrated in a study from Turkey that 30 per cent of patients with final PMR diagnosis were hospitalized, 30 per cent were treated with antibiotics, and in 29, 22 and 19 per cent abdominal, chest and brain computed tomography (CT), respectively, were performed. This approach seemed reasonable; however, there were still 13±13 months delay from onset of symptoms to diagnosis 46 .…”

Section: Diagnosis By Excluding Other Causes Of Similar Symptomsmentioning

confidence: 99%

Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient

Milchert

Brzosko

2017

Indian Journal of Medical Research

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Polymyalgia rheumatica (PMR) is a unique disease of elderly people, traditionally diagnosed based on a clinical picture. A typical case is a combination of severe musculoskeletal symptoms and systemic inflammatory response with spectacular response to corticosteroids treatment. The severity of symptoms may be surprising in older patients where immunosenescence is normally expected. However, PMR may be diagnosed in haste if there is a temptation to use this diagnosis as a shortcut to achieve rapid therapeutic success. Overdiagnosis of PMR may cause more problems compared to underdiagnosis. The 2012 PMR criteria proposed by European League against Rheumatism/American College of Rheumatology aim to minimize the role of clinical intuition and build on more objective features. However, questions arise if this is possible in PMR. This has been discussed in this review.

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The process from symptom onset to rheumatology clinic in polymyalgia rheumatica

Cited by 18 publications

References 12 publications

Diagnosis of polymyalgia rheumatica in primary health care: favoring and confounding factors – a cohort study

Diagnosis of polymyalgia rheumatica in primary health care: favoring and confounding factors – a cohort study

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

Diagnosis of polymyalgia rheumatica usually means a favourable outcome for your patient

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