Polymyalgia rheumatica: clinical features and diagnostics

Abstract

Current data on epidemiology, pathomorphology, clinical manifestations and diagnosis of polymyalgia rheumatica is presented. Polymyalgia rheumatica occurs only in persons over 50 years of age. The etiological factors of the disease remain unknown. The pathomorphology of the disease is characterized by the absence of polyorganity and morphological changes in the study of biopsies of diseased muscles, inflammation of predominantly extraarticular synovial structures. The pain in the muscles has a constant, usually aching character, sharply increased during movement and persists at night. The intensity of pain depends on the activity of the disease. The use of non-steroidal anti-inflammatory drugs has no significant effect on the intensity of myalgia. Often, a few weeks after the onset of the disease, seronegative arthritis appears. Synovitis is characterized by a benign course, absence of erosive changes in the joint and joint deformities. Symptoms of the disease grow gradually, reaching a maximum severity within a month. Characteristic is the appearance of anorexia and depression, weight loss, it is possible to attach subfebrile or febrile fever. In some patients there are signs of inflammation of the vessels in the form of subclinical, weakly expressed vasculitis or giant cell arteritis with lesions of the extracranial branches of the carotid arteries and signs of vascular insufficiency in the blood supplying organs. Specific laboratory criteria for polymyalgia rheumatica do not exist. Diagnosis of the disease is based on the analysis of a number of clinical, laboratory and instrumental features, united by experts of the European League against rheumatism and the American College of Rheumatology in the form of diagnostic criteria for rheumatic polymyalgia. The disease has a polymorphic clinical picture and similarity of symptoms with inflammatory diseases of the joints, as well as with myopathies against a background of various pathologies of internal organs and systems. Despite the presence of diagnostic criteria, the diagnosis is established after the exclusion of diseases with similar clinical manifestations. Recognition of polymyalgia rheumaticа is often associated with a large volume of research, which makes the disease difficult in a differential diagnostic plan and contributes to an increase in the duration of the verification period of the diagnosis.