The role of the general practitioner and the out-of-hospital public rheumatologist in the diagnosis and follow-up of patients with polymyalgia rheumatica

Abstract

SUMMARYPolymyalgia rheumatica (PMR) is a chronic inflammatory disease characterized by shoulder and pelvic girdle pain. Its onset peaks around the age of 75; the prevalence increases until the age of 90 and it is more frequent in females. Diagnosis is mostly performed on the basis of symptoms. An increase of serum inflammatory markers is indicative, but not essential, while therapy is mainly based on glucocorticoids. Since there is no universal agreement about diagnostic criteria for PMR, its detection is still difficult. There are discordant opinions about the fact that PMR can be recognised and managed by general practitioners (GPs), while patients with atypical features need to be referred to the rheumatologist. In the Italian setting, the absence of recent epidemiological studies is associated with the total lack of a research protocol in primary care, from which relevant information could be derived. The out-of-hospital public rheumatologist is a peculiar figure of the Italian National Health System, who takes care of outpatients. Although differences between the different Italian regional health services exist, this professional figure has proved to be effective in reducing delay and increasing accuracy in PMR diagnosis.

Subjective sleep disturbances at the time of diagnosis in patients with polymyalgia rheumatica and in patients with seronegative elderly-onset rheumatoid arthritis. A pilot study

“…In Table II, we did not list ESR values. It is common knowledge that in a proportion of PMR patients -from 7 up to 22% -ESR is not raised at the time of diagnosis [40,41]. Moreover, ESR can depend on several variables, whereas this does not happen with CRP concentrations [42].…”

If something looks like an apple, is it necessarily an apple? Some considerations about so-called “statin-induced polymyalgia rheumatica”

“…When studies are performed using incomplete databases, this risk is very high. In this specific case, we know that the general practitioner (GP) is usually the first physician who examines the PMR patient [4, 30, 31], that many PMR patients are not referred to rheumatologists [32], that the level of the GP’s diagnostic accuracy is often low [33], and that PMR is not a straightforward disease [25].…”

Incidence and Prevalence of Polymyalgia Rheumatica (PMR): The Importance of the Epidemiological Context. The Italian Case

“…The possibility that PMR may onset in a centenarian man has recently been described [6]. The general practitioner (GP) is usually the first physician who examines the PMR patient, and many PMR patients are not referred to rheumatologists [26,27,28,29,30]. In a study from the UK only 44.4% of patients with PMR underwent specialist consultant evaluation [8]; in another study, this percentage dropped to 17% [26].…”

“…In a study from the UK only 44.4% of patients with PMR underwent specialist consultant evaluation [8]; in another study, this percentage dropped to 17% [26]. In Italy, the presence of a professional figure represented by the out-of-hospital public specialist (specifically, an out-of-hospital public rheumatologist) introduces an element of substantial differentiation with the recognition of a dividing line between GPs and centers of the so-called second or third level, totally absent in other nations [2,28,30].…”