Cases Of Polymyalgia Rheumatica Research Articles

Incidence of rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica in an inland area of central Italy: results of the CAMPO-RHE study

ABSTRACTObjective: The aim of the CAMPO-RHE study was to determine the incidence of rheumatoid arthritis (RA), psoriatic arthritis (PsA) and polymyalgia rheumatica (PMR) in patients attending a rheumatologic outpatient’s clinic of a new institution in Campobasso, Italy.Methods: Campobasso is a small town of approximately 50,000 inhabitants located in the inland territory of central Italy (Molise), and Public Health is managed from a single health authority. In Italy, all citizens are registered with a National Health System of General Practitioner (GP) Physicians. Between the 1st of June 2014 and the 31st of May 2016, all consecutive adult patients, sent by a GP, of Campobasso with any diagnosis of musculoskeletal symptoms/signs/complaints were evaluated in a single rheumatology outpatient clinic of our Academic Unit. The clinic represents the first and unique reference for GPs about rheumatic diseases in the territory. Subjects were classified using the 2010 EULAR criteria for RA, the CASPAR criteria for PsA and the 2012 ACR classification criteria for PMR.Results: 1003 adult patients, sent by GPs, with articular or musculoskeletal complaints visited our clinic. Of these, 409 inhabitants of the municipality of Campobasso were evaluated for the study. During the 2-year study period we diagnosed 18, 19 and 12 new cases of RA, PsA and PMR respectively, with a new incident cases rate of 21.4, 22.59 and 27.43/100,000/year on the population at risk.Conclusion: The results of our study could contribute to better define the incidence of these rheumatic diseases classified with the new classification criteria.

Epidemiology of Polymyalgia Rheumatica 2000-2014 and Examination of Incidence and Survival Trends Over 45 Years: A Population-Based Study.

To determine time trends in the incidence and survival of polymyalgia rheumatica (PMR) over a 15-year period in Olmsted County, Minnesota, and to examine trends in incidence of PMR in the population by comparing this time period to a previous incidence cohort from the same population base. All cases of incident PMR among Olmsted County, Minnesota residents in 2000-2014 were identified to extend the previous 1970-1999 cohort. Detailed review of all individual medical records was performed. Incidence rates were age- and sex-adjusted to the US white 2010 population. Survival rates were compared with the expected rates in the population of Minnesota. There were 377 incident cases of PMR during the 15-year study period. Of these, 64% were female and the mean age at incidence was 74.1 years. The overall age- and sex-adjusted annual incidence of PMR was 63.9 (95% confidence interval [95% CI] 57.4-70.4) per 100,000 population ages ≥50 years. Incidence rates increased with age in both sexes, but incidence fell after age 80 years. There was a slight increase in incidence of PMR in the recent time period compared to 1970-1999 (P = 0.063). Mortality among individuals with PMR was not significantly worse than that expected in the general population (standardized mortality ratio 0.70 [95% CI 0.57-0.85]). The incidence of PMR has increased slightly in the past 15 years compared to previous decades. Survivorship in patients with PMR is not worse than in the general population.

Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015.

There are no estimates of the prevalence of giant cell arteritis (GCA) or polymyalgia rheumatica (PMR) in a US population in the current millennium. The purpose of this study was to estimate the 2015 prevalence of GCA and PMR in a US population-based setting. Cohorts of incident GCA in 1950-2009 and incident PMR in 1970-2014 were previously identified among residents of Olmsted County, Minnesota. Prevalence estimates were obtained from the age-, sex-, and calendar year-specific incidence rates and adjusted to the US white 2010 population aged ≥50 years. Confidence intervals (CI) were computed using bootstrap sampling. There were 248 incident cases of GCA in 1950-2009 and 790 cases of PMR in 1970-2014. The overall age- and sex-adjusted prevalence rate of GCA on January 1, 2015 was 204 (95% CI: 161-254) per 100,000 population aged ≥50 years. GCA prevalence rate in women was 304 (95% CI: 229-375) and in men was 91 (95% CI: 46-156) per 100,000 population. The overall age and sex adjusted prevalence rate of PMR on January 1, 2015 was 701 (95% CI: 651-750) per 100,000 population. PMR prevalence rate in women was 870 (95% CI: 787-957) and in men was 508 (95% CI: 426-589) per 100,000 population. Prevalence rates of GCA and PMR in 2015 are similar to previously published prevalence estimates in the late 1990s. The health burden of these diseases among older persons continues to be substantial and reflects the need for continued efforts to better manage it.

Polymyalgia Rheumatica After Influenza Vaccine

Influenza is an acute upper respiratory tract infection that occurs in epidemics almost every year, and is caused by influenza A and B viruses. It can cause serious complications including death especially in older adults and individuals with underlying health problems. Influenza vaccination is a very effective way of preventing influenza and is recommended by CDC. The common side effects of the vaccine vary from mild injection site reactions, to rhinorrhea, nasal congestion, headache and sore throat. On the other hand, there have been very rare reports of Guillain-Barre’s syndrome and also some cases of polymyalgia rheumatica (PMR) after influenza vaccine. Our patient, an 86-year-old female, presented with bilateral shoulder and hip pain, and stiffness 2 weeks after she received her influenza vaccine, and both the patient and family were very adamant and upset that the problem was caused by the vaccination. Patient’s erythrocyte sedimentation rate and C-reactive protein were elevated, a clinical diagnosis of PMR was made, and she was started on steroids to which she had a dramatic response. While we strongly recommend the administration of influenza vaccination, we also want to create awareness among the clinicians of this possibility, and proper education of the patients regarding this existence and the fact that if it happens at all, there is a treatment for it, and it should not discourage the patients from getting the vaccine in future. Also this association would need more studies in future. J Med Cases. 2017;8(4):117-118 doi: https://doi.org/10.14740/jmc2788w

Proliferative Synovitis of the Shoulder Bursae is a Key Feature for Discriminating Elderly Onset Rheumatoid Arthritis Mimicking Polymyalgia Rheumatica From Polymyalgia Rheumatica.

Semiquantitative scoring for subacromial bursa (SAB), subdeltoid bursa (SDB), and subcoracoid bursa by both gray-scale (GS) and power Doppler (PD) ultrasonography was performed in 15 patients with polymyalgia rheumatica (PMR) (72.6 ± 7.7 years old) and 15 patients with elderly onset rheumatoid arthritis with PMR-like onset (pm-EORA) (70.7 ± 7.0 years old) before starting treatment. The GS grades of SAB were significantly higher in the shoulders with pm-EORA than in the shoulders with PMR. The GS and PD scores of SAB and the PD scores of SDB were significantly higher in pm-EORA than in PMR cases. The sums of GS and/or PD scores for the three bursae were significantly higher in pm-EORA than in patients with PMR. The sums of GS and PD scores for SAB were significantly higher in pm-EORA than in PMR cases. Moderate to severe proliferative synovitis of the shoulder bursae, especially in SAB, is a key feature for discriminating pm-EORA from PMR.

顎関節に症状を来たしたリウマチ性多発筋痛症の1例

顎関節に症状を来たしたリウマチ性多発筋痛症の1例

Polymyalgia Rheumatica and Asthma Attack Presenting as the Initial Symptoms of Gastric Cancer

Gastric cancer has varied clinical manifestations, sometimes the symptoms seem to be nothing related to the gastrointestinal diseases, which makes it difficult for doctors to come to the correct diagnosis of gastric cancer in those patients. We report a case of polymyalgia Rheumatica and intermittent asthma attack presenting as the initial symptoms of gastric cancer. A 51-year-old female visited our hospital with complaint of multi-point pain of her body for three months, accompanied with asthma-like attack and abdominal mass for 2 weeks. All the results of rheumatoid factor and antinuclear factor were negative. She didn't get any benefit from the treatment of prednisone, MTX and folic acid. Then upper gastrointestinal(GI) endoscopy demonstrated a gastric cancer. The patient underwent radical gastrectomy with D2 lymph node dissection and complex of intestinal adhesion release, her polymyalgia Rheumatica and asthma-like attack were relieved 1 week later, she gained weight and received chemotherapy. Followed up 6 years by for now, she was found going well without any evidence of recurrence of cancer or any episode of flareup of polymyalgia Rheumatica or asthma. This indicates that when doctors met patients whose clinical manifestations were shown as refractory ones, the underlying cancer should be under consideration.

Polymyalgia Rheumatica Revealing a Lymphoma: A Two-Case Report.

Introduction. Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatism types in elderly population. The link between cancer and PMR is a matter of debate. Methods. We report two cases of PMR leading to the diagnosis of lymphoma and the growing interest of PET-TDM in this indication. Results. A 84-year-old man known for idiopathic neutropenia presented an inflammatory arthromyalgia of the limb girdle since one month. Blood exams highlighted the presence of a monoclonal B cell clone. Bone marrow concluded to a B cell lymphoma of the marginal zone. He was successfully treated with 0.3 mg/kg/d of prednisone, and response was sustained after 6 months. A 73-year-old man known for prostatic neoplasia in remission for 5 years presented arthromyalgia of the limb girdle since one month. PET-CT revealed bursitis of the hips and the shoulders, no prostatic cancer recurrence, and a metabolically active iliac lymphadenopathy whose pathologic exam concluded to a low grade follicular lymphoma. He was successfully treated with 0.3 mg/kg/d of prednisone. Conclusion. These observations may imply that lymphoma is sometimes already present when PMR is diagnosed and PET-CT is a useful tool in the initial assessment of PMR to avoid missing neoplasia.

Whole-body MRI of patients with polymyalgia rheumatica identifies a distinct subset with complete patient-reported response to glucocorticoids

ObjectivesTo determine whether whole-body MRI defines clinically relevant subgroups within polymyalgia rheumatica (PMR) including glucocorticoid responsiveness.Methods22 patients with PMR and 16 with rheumatoid arthritis (RA), untreated and diagnosed by consultant...

Accuracy of musculoskeletal imaging for the diagnosis of polymyalgia rheumatica: systematic review

ObjectivesTo review the evidence for accuracy of imaging for diagnosis of polymyalgia rheumatica (PMR).MethodsSearches included MEDLINE, EMBASE and PubMed. Evaluations of diagnostic accuracy of imaging tests for PMR were eligible,...

Effective Control of Polymyalgia Rheumatica With Tocilizumab

Despite their disadvantages, glucocorticoids (GCs) remain a mainstay of therapy for polymyalgia rheumatica (PMR). Second-line antirheumatic and immune-modulatory drugs are not infrequently required because of disease relapses during GC tapering and GC adverse effects. Therapy with methotrexate or with an anti-tumor necrosis factor drug showed modest efficacy in this situation. Tocilizumab (TCZ) is an anti-interleukin 6 receptor antibody that is being recently studied in the treatment of PMR patients who are intolerant or refractory to GCs, especially after failure of a second-line agent. We report a case of PMR in which GCs were stopped because of adverse effects despite good response. The condition responded to neither methotrexate nor etanercept. Treatment with TCZ has led to significant improvement of the patient's clinical and biochemical PMR activity parameters, and she was kept in a solid remission for 1 year without any TCZ-related adverse effects. Tocilizumab is a promising drug in the management of PMR. Further studies are required to clearly define the indications and duration of TCZ therapy in the management of PMR.

Is cancer associated with polymyalgia rheumatica? A cohort study in the General Practice Research Database

ObjectiveTo investigate the incidence of new cancer diagnoses in a community sample of patients with polymyalgia rheumatica (PMR).MethodsAll incident cases of PMR in the UK General Practice Research Database (GPRD)...

Polymyalgia rheumatica

With the increased life expectancy and associated comorbidities in haemophilic patients, greater awareness is needed to avoid being misled by symptoms mimicking haemophilia-related conditions. Here, we discuss the case of a 77-year-old man with congenital moderate haemophilia complicated by diffuse haemophilic arthropathy. He presented with persistent pain and stiffness affecting both shoulder and pelvic girdles, unresponsive to factor VIII (FVIII) infusions. A blood test confirmed the high clinical suspicion of polymyalgia rheumatica (PMR), justifying a course of low-dose methylprednisolone that led to significant clinical and biological improvement. This is the first reported case of congenital haemophilia and PMR. We here review some elements helpful to overcome this diagnostic challenge. Adequate diagnosis and management of PMR in elderly patients with haemophilia is particularly important not only to relieve pain but also to avoid inappropriate use of clotting factor concentrates.

Polymyalgia rheumatica in a married couple

The case of a married couple developing polymyalgia rheumatica (PMR) consecutively is presented. The 55-year-old wife complained in June 2010 about pain in her neck. Case history, physical examination, and erythrocyte sedimentation rate (ESR) of 80 mm/hour led to the diagnosis of PMR. In May 2011, her 66-year old husband complained about pain in his neck, shoulders, buttocks, and thighs. Considering anamnesis, physical examination, and ESR of 56 mm/hour, the diagnosis of PMR was made. Both wife and husband responded to steroid treatment. When the steroid dose was gradually reduced, both patients relapsed. In order to lower the cumulative dose of glucocorticoid therapy, 10 mg methotrexate per week was added. In the literature, six cases of polymyalgia rheumatica in married couples have been described to date. In four cases, polymyalgia rheumatica occurred first in the wife. The interval of the diagnosis between the spouses ranged from 0 to 89 months. Although in most of the previous case reports a genetic disposition and an infectious agent have been discussed, this hypothesis must be questioned.

Diagnosis and management of polymyalgia rheumatica

Helliwell et al wrote an excellent article on the diagnosis and management of polymyalgia rheumatica, but I do question one of their statements that the average full-time GP would see five new cases of polymyalgia rheumatica (PMR) per year.1

Diagnosis and management of polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is the commonest inflammatory rheumatic disorder affecting older people.1 Patients typically present with bilateral shoulder pain, morning stiffness, raised inflammatory markers, and have a rapid response to low-dose corticosteroids. There is no gold standard diagnostic test and despite being first described in 1888, controversies still exist as to its defining characteristics. PMR carries a lifetime risk of 2.4% for females and 1.7% for males.2 The incidence in the UK has been shown to be 8.42 per 10 000 person years.3 In the UK, the majority of patients are managed exclusively in primary care4 with an average full-time GP seeing five new cases of PMR per year.5 Accurate diagnosis can be challenging even for specialists, but is essential as many serious illnesses can mimic PMR. Guidelines for the diagnosis and management of PMR have recently been published by the British Society of Rheumatologists (BSR) and British Health Professionals in Rheumatology (BHPR).6 Consider PMR in patients over the age of 50 years with: Subsequent clinical assessment and investigations should …

Therapy of rheumatic polymyalgia: the pathophysiologic management

Polymyalgia rheumatica (PMR) is an inflammatory syndrome affecting older people whose prevalence has increased in recent years. The suppression of the hypothalamic-pituitary-adrenal axis (HPA) and ageing may contribute to the pathogenesis of PMR. Chronic stress (i.e. interpersonal, chronic infections etc.) in elderly people may represent a risk factor for the development of PMR. In fact, elderly represent per se a condition of endocrine senescence including adrenal hypofunction, in addition chronic stress represents a further harmful stimulus to seriously compromise endogenous glucocorticoid production. Synovitis and vasculitis characterize the majority of the patients. Serum cytokine and steroidal hormone patterns suggest that patients with PMR have an intensive inflammatory reaction. As a matter of fact, glucocorticoids represent the most useful temporary "replacement" treatment during the active phase of PMR. The use of modified-release glucocorticoids that might induce higher levels during the night (circadian rhythms as in physiological conditions), will represent another important approach to optimize PMR treatment and reduce the side effects. Combination therapy between glucocorticoids and inhibitors of pro-inflammatory cytokines should be tested in large studies and early cases of PMR.

Anterior Uveitis as an Initial Manifestation of Polymyalgia Rheumatica

A 74-year-old woman without contributory medical history presented with acute iridocyclitis in the right eye. Although the iridocyclitis disappeared within two weeks under topical steroid, she complained of acute progressing bilateral shoulder pain and morning stiffness of upper extremities. She was diagnosed as having polymyalgia rheumatica (PMR), and iridocyclitis was considered as its related manifestation. PMR and giant cell arteritis (GCA) are closely related conditions and frequently occur together. GCA with uveitis has been rarely noted. However, ocular symptoms in PMR have not been previously mentioned. This is a first reported case of PMR presented with uveitis, without a complication of GCA. This anterior uveitis might be caused by ischemia of the posterior ciliary arteries and their branches.

A Case of Transient ACTH Deficiency Associated with Polymyalgia Rheumatica

We report a case of 79-year-old man, who was diagnosed to have transient ACTH deficiency associated with polymyalgia rheumatica (PMR). The patient presented with sudden onset bilateral shoulder pain, which was gradually aggravated. Plasma ACTH was undetectable, and both serum cortisol and urinary 17-OHCS were very low. Other pituitary hormones were normal, suggesting that hypothalamo-pituitary-adrenal (HPA) axis is selectively damaged. However, within several weeks, plasma ACTH returned to normal, and showed a normal increase response to corticotropin-releasing hormone stimulation test. These results indicated that ACTH deficiency was only transient. After hydrocortisone (10 mg/day) was administered, his symptoms became suddenly improved. Based on those results and clinical course, ie, elevated erythrocyte sedimentation rate, negative rheumatoid factor and the typical symptoms, which showed improvement to glulcocorticoid therapy, the final diagnosis was PMR, which was associated with transient ACTH deficiency.This is the first report of a case of PMR, in which the HPA axis was examined in its very acute phase. It was demonstrated that the case was associated with the transient adrenocortical hypofunction, which was recovered during a short time. It is therefore possible that PMR may show a different responsiveness of HPA axis depending on its phases.

A case of polymyalgia rheumatica where a complication of large-vessel vasculitis was diagnosed by FDG-PET

The patient was a 74-year-old female presenting with abrupt onset of fever and proximal muscle pains. She had been diagnosed with polymyalgia rheumatica (PMR). On physical examination, there was no tenderness or dilatation of the temporal artery and ocular fundi were normal. 18F-FDG-PET revealed accumulation of FDG in the aorta as well as in the bilateral subclavian arteries, which strongly suggested inflammation of the large blood vessels. Magnetic resonance angiography disclosed stenosis of the bilateral subclavian arteries, which was consistent with angitis. This case was considered to have developed PMR at an old age with positive HLA DR4, and to have a complication large-vessel giant cell arteritis (LV-GCA). Administration of prednisolone at a dose of 20 mg/day promptly relieved the fever and the myalgia as well. It is difficult to diagnose GCA in PMR if no tenderness or dilatation of the temporal artery is present. FDG-PET is considered useful, not only for exploration of tumors, but also for evaluation of inflammation of large vessels.