Polymyalgia Rheumatica In Patients Research Articles

Polymyalgia rheumatica and giant cell arteritis: A bidirectional Mendelian randomization study.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) as 2 types of autoimmune diseases are frequently concomitant, and Mendelian randomization (MR) was applied in this study to assess the causal relationship between them. In this study, single-nucleotide polymorphism (SNP) was used as the instrumental variable for Mendelian analysis, and the SNP data of GCA and PMR were obtained from the FinnGen Biobank databases. SNPs are significantly correlated with GCA and PMR and were screened based on preset thresholds. Inverse variance weighted analysis was used as the main analysis, supplemented with MR-Egger and weighted median. The evidence of the impact of GCA on PMR risk was found in inverse variance weighted results (odds ratio, 1.22 [95% confidence interval, 1.11-1.34]; P < .01), and the evidence of the impact of PMR on GCA risk has also been found (odds ratio, 1.58 [95% confidence interval, 1.28-1.96]; P < .01). Finally, the stability and reliability of the results were tested using the retention method, heterogeneity test, and horizontal gene pleiotropy test. MR analysis indicates that GCA increases the risk of PMR and PMR is an important risk factor for GCA, with a causal relationship. The potential value of reasonable management of PMR in patients with GCA has received high attention. In addition, novel GCA therapeutics may be indicated for PMR, and it is a potential for further investigation.

Successful treatment of aggressive AA amyloidosis with tocilizumab in a patient with polymyalgia rheumatica.

Polymyalgia rheumatica associated amyloidosis is an extremely rare condition that can be rapidly progressive with high morbidity and mortality and management is challenging. Tocilizumab is a monoclonal anti IL-6 receptor antibody which is in the therapeutic arsenal of polymyalgia rheumatica. The efficiency of tocilizumab in improvement of polymyalgia rheumatica activity score and decreasing steroid dose is well established, while efficiency in polymyalgia rheumatica associated amyloidosis has not been published. Herein, we reported a polymyalgia rheumatica patient with AA amyloidosis who was treated effectively with tocilizumab.

18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Findings of Polymyalgia Rheumatica in Patients with Giant Cell Arteritis.

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are often overlapping conditions. We studied whether 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is useful in identifying PMR in the setting of large vessel (LV) GCA. LV-GCA patients diagnosed by PET-CT at a tertiary care center for a population of 450,000 people over a two-year period were reviewed. Scoring was performed based on potential significant FDG uptake at up to 16 sites in nine different extravascular areas (SCORE 16). Differences in extravascular sites of significant FDG uptake were evaluated between LV-GCA with a clinical diagnosis of PMR or not. Fifty-four patients were diagnosed with LV-GCA by 18F-FDG-PET-CT. Of them, 21 (38.8%) were clinically diagnosed with PMR. Significant extravascular FDG uptake was more frequently observed in those with a clinical diagnosis of PMR. In this sense, the SCORE 16 was higher in those with clinical PMR (5.10 ± 4.05 versus 1.73 ± 2.31 in those without a clinical diagnosis of PMR; p < 0.001). A SCORE 16 involving more than four sites of significant FDG uptake yielded a sensitivity of 52% and a specificity of 91% for establishing a clinical diagnosis of PMR associated with LV-GCA. The best areas of significant FDG uptake to clinically identify PMR in patients with LV-GCA were the shoulder, the greater trochanter, and the lumbar interspinous regions, with an area under the ROC curve of 0.810 (0.691-0.930). Significant extravascular 18F-FDG-PET-CT uptake may help establish a clinical diagnosis of PMR in patients with LV-GCA. These patients are more commonly diagnosed with PMR if they have significant FDG uptake in the shoulder, greater trochanter, and lumbar interspinous areas.

Test-retest reliability of pain VAS/NRS, stiffness VAS/NRS, HAQ-DI and mHAQ in polymyalgia rheumatica: An OMERACT study

ObjectiveTo examine the test-retest reliability of four measurement instruments in polymyalgia rheumatica (PMR): pain severity visual analogue scale (VAS) / numerical rating score (NRS), stiffness severity VAS/NRS, the Health Assessment Questionnaire-Disability Index (HAQ-DI) and the modified Health Assessment Questionnaire (mHAQ). MethodTwo prospectively collected datasets were used. All participants had a diagnosis of PMR and only those with stable disease were included in analyses. Measurement instruments were administered twice, with a testing interval of two to six weeks. The intra-class correlation coefficient (ICC) was calculated using a two-way mixed effects model looking for absolute agreement. ICC values of 0.8-0.9 were deemed representative of good test-retest reliability, whilst values >0.9 were representative of excellent test-retest reliability. ResultsFrom the first dataset, 38 participants were analysed. The ICC between baseline and 2 weeks for pain VAS, stiffness VAS, HAQ-DI and mHAQ were 0.84, 0.82, 0.92 and 0.92 respectively.From the second dataset, 58 participants were included in the analysis for pain NRS, 59 for stiffness NRS and 78 for mHAQ. The ICC between baseline and follow-up for pain NRS, stiffness NRS and mHAQ were 0.80, 0.83 and 0.87 respectively. ConclusionPain severity VAS/NRS, stiffness severity VAS/NRS, HAQ-DI and mHAQ all demonstrate good to excellent test-retest reliability in a PMR patient population.

Comparison of Shoulder Ultrasonographic Assessments between Polymyalgia Rheumatica and Frozen Shoulder in Patients with Bilateral Shoulder Pain: A Comparative Retrospective Study.

This study aimed to assess and compare the ultrasonographic (US) pathologic findings in patients with polymyalgia rheumatica (PMR) and bilateral frozen shoulder (FS). We included 19 patients with clinically diagnosed PMR and 19 patients with stage II bilateral FS. The US evaluation included the assessment of subacromial-subdeltoid (SASD) bursitis, long head of biceps (LHB) tenosynovitis, and posterior and inferior glenohumeral (GH) synovitis. Unilateral SASD bursitis was noted significantly more frequently in PMR patients than in bilateral FS patients (p = 0.001). There were no significant differences in the incidence of unilateral LHB tenosynovitis and posterior GH synovitis between PMR and bilateral FS patients (p = 0.108 and p = 0.304, respectively). Unilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p < 0.001). Bilateral SASD bursitis and LHB tenosynovitis were noted significantly more frequently in PMR patients than in bilateral FS patients (p < 0.001 and 0.049, respectively). Significant differences were not observed in the incidence of bilateral posterior GH synovitis between PMR and bilateral FS patients (p = 0.426). Bilateral inferior GH synovitis was more common among bilateral FS patients than among PMR patients (p = 0.044). The US evidence for bilateral inferior GH synovitis without bilateral SASD showed high specificity (94.7%) with sensitivity (78.9%) for the diagnosis of bilateral FS. SASD bursitis, representing periarticular synovial inflammation, was more common among the patients with PMR than among the patients with bilateral FS. Inferior GH synovitis without SASD bursitis suggests FS rather than PMR in patients with bilateral shoulder pain.

If something looks like an apple, is it necessarily an apple? - reflections on so-called "statin-induced polymyalgia rheumatica".

The existence of polymyalgia rheumatica (PMR) induced by statins has been hypothesised by some investigators. This review article highlights the fact that there is no evidence it is real. On the contrary, PMR and statin-associated muscle symptoms (SAMS) are two totally different conditions. Shoulder and hip ultrasound (US) examinations can make an important contribution in distinguishing a true case of PMR from a PMR-like illness induced by statins. The possibility that SAMS may worsen the clinical manifestations of a PMR patient should be taken into account in clinical practice, and drug discontinuation should be proposed when deterioration or relapse is not otherwise justifiable.

Identification of an activated neutrophil phenotype in polymyalgia rheumatica during steroid treatment: a potential involvement of immune cell cross-talk.

We have reported the existence of a distinct neutrophil phenotype in giant cell arteritis (GCA) patients arising at week 24 of steroid treatment. In the present study, we investigated whether longitudinal analysis of neutrophil phenotype in patients with polymyalgia rheumatica (PMR) could reveal a novel association with disease status and immune cell cross-talk. Thus, we monitored PMR patient neutrophil phenotype and plasma microvesicle (MV) profiles in blood aliquots collected pre-steroid, and then at weeks 1, 4, 12 and 24 post-steroid treatment.Using flow cytometric and flow chamber analyses, we identified 12-week post-steroid as a pivotal time-point for a marked degree of neutrophil activation, correlating with disease activity. Analyses of plasma MVs indicated elevated AnxA1+ neutrophil-derived vesicles which, in vitro, modulated T-cell reactivity, suggesting distinct neutrophil phenotypic and cross-talk changes at 24 weeks, but not at 12-week post-steroid.Together, these data indicate a clear distinction from GCA patient neutrophil and MV signatures, and provide an opportunity for further investigations on how to ‘stratify’ PMR patients and monitor their clinical responses through novel use of blood biomarkers.

76-Year-Old Man With New Bilateral Shoulder Pain

76-Year-Old Man With New Bilateral Shoulder Pain

How common is depression in patients with polymyalgia rheumatica?

Depression is common in inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus and negatively impacts on outcomes. Given the long-term nature of polymyalgia rheumatica (PMR) and its glucocorticoid treatment, these patients may be at an increased risk of depression, although few studies exist to date. This study aimed to investigate the prevalence of, and factors associated with, depression in PMR patients. Prevalent PMR patients (with a first diagnostic code for PMR in the last 3years) were mailed a postal questionnaire (n=704) examining PMR symptoms, glucocorticoid use and patient reported comorbidities. Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8), with a score of ≥10 defined as current depressive symptoms. Logistic regression was used to examine association between demographics, comorbidity and current depressive symptoms. Five hundred fifty (78%) patients responded, of which 365 (66%) were female, with a mean (SD) age of 74.1years (8.4). The prevalence of current depressive symptoms was 15% (n=81) and was significantly associated with female gender: OR 1.87 (95%CI 1.08-3.22), current PMR symptoms: OR 2.1 (1.11-3.97), self-reported acid reflux: OR 1.75 (1.05-2.93) and diabetes: OR 2.86 (1.6-5.09). Older patients were less likely to report current depressive symptoms (OR 0.35 (0.13-0.9) for those >80years versus those aged 50-59years). Depressive symptoms are common in patients with PMR patients, especially younger patients and those with comorbidities. Clinicians should consider screening these patients for depressive symptoms and managing them appropriately, as untreated depression may negatively impact on health-related outcomes and quality of life.

050. How Common is Depression in Patients with Polymyalgia Rheumatica?

Depression is common in inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus and negatively impacts on outcomes. Given the long-term nature of polymyalgia rheumatica (PMR) and its glucocorticoid treatment, these patients may be at an increased risk of depression, although few studies exist to date. This study aimed to investigate the prevalence of, and factors associated with, depression in PMR patients. Prevalent PMR patients (with a first diagnostic code for PMR in the last 3 years) were mailed a postal questionnaire (n = 704) examining PMR symptoms, glucocorticoid use and patient reported comorbidities. Depressive symptoms were assessed using the Patient Health Questionnaire-8 (PHQ-8), with a score of ≥10 defined as current depressive symptoms. Logistic regression was used to examine association between demographics, comorbidity and current depressive symptoms. Five hundred fifty (78%) patients responded, of which 365 (66%) were female, with a mean (SD) age of 74.1 years (8.4). The prevalence of current depressive symptoms was 15% (n = 81) and was significantly associated with female gender: OR 1.87 (95%CI 1.08–3.22), current PMR symptoms: OR 2.1 (1.11–3.97), self-reported acid reflux: OR 1.75 (1.05–2.93) and diabetes: OR 2.86 (1.6–5.09). Older patients were less likely to report current depressive symptoms (OR 0.35 (0.13–0.9) for those >80 years versus those aged 50–59 years). Depressive symptoms are common in patients with PMR patients, especially younger patients and those with comorbidities. Clinicians should consider screening these patients for depressive symptoms and managing them appropriately, as untreated depression may negatively impact on health-related outcomes and quality of life.

Pneumatosis cystoides intestinalis related to α-glucosidase inhibitor treatment in a polymyalgia rheumatica patient with diabetes mellitus

The patient presented in this case was an 83-year-old female who was referred to our department for a detailed examination and treatment of a diabetic foot. She had history of treatment with continuous oral steroid therapy (8 mg/day) for polymyalgia rheumatica (PMR), insulin therapy (NovoRapid 30 Mix: 8 units in the morning and 2 units in the evening), and oral treatment with acarbose (100 mg, 3T) for diabetes. Although she did not complain of abdominal fullness or pain, a routine abdominal X-ray revealed free air below the diaphragm and noticeable gaseous distention in the ascending and transverse colon. Abdominal CT demonstrated dilatation, mesenteric edema, and diffuse pneumatosis intestinalis throughout the ascending and transverse colon. A diagnosis of pneumatosis cystoides intestinalis (PCI) was made based on these findings. As the α-glucosidase inhibitor (α-GI) was suspected to be the cause of the PCI, we administered conservative treatment, discontinuing acarbose with fasting and fluid supplementation. The patient progressed well, and 3 weeks later, an abdominal X-ray and CT scan confirmed the disappearance of the pneumocystis lesions in the colon. With the recent rise in the number of elderly individuals and increased awareness of PMR, the number of reported patients with PMR receiving steroid therapy in Japan has increased. Therefore, the incidence of PMR among elderly patients with diabetes mellitus receiving α-GI and steroid therapy is anticipated to increase in the future. Hence, PCI should be carefully assessed as a possible complication and the gastrointestinal tract should be investigated in such patients.

OP0298-PC How General Practitioners Diagnose Polymyalgia Rheumatica

BackgroundThe initial diagnosis of polymyalgia rheumatica (PMR) is often made in primary care. Given the non-specific nature of PMR symptoms, diagnosis can be challenging especially as many disorders can mimic...

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 …

Ophthalmic presentation of Wegener's granulomatosis on a background of polymyalgia rheumatica

We present a case of Wegener's granulomatosis (WG) in a 79-year-old man with limbitis and granulomatous conjunctivitis, on a background of polymyalgia rheumatica (PMR). The undifferentiated nature of ocular presentations of WG can be diagnostically challenging, especially in cases, such as this, where findings are initially inconclusive and evolve with time. This case highlights the significance of a history of PMR in patients with ocular inflammation. The systemic inflammatory systems of WG, including arthralgias, may mimic other conditions such as PMR. Patients with undifferentiated ocular inflammatory syndromes should be questioned regarding arthralgias, myalgias and stiffness. Such symptoms, or a background of PMR, should raise suspicion of WG.

Evidence for a different anatomic basis for joint disease localization in polymyalgia rheumatica in comparison with rheumatoid arthritis

The anatomic basis for joint disease localization in polymyalgia rheumatica (PMR) is poorly understood. This study used contrast-enhanced and fat suppression magnetic resonance imaging (MRI) to evaluate the relationship between synovial and extracapsular inflammation in PMR and early rheumatoid arthritis (RA). Ten patients with new-onset PMR and 10 patients with early RA underwent dynamic contrast-enhanced MRI and conventional MRI of affected metacarpophalangeal (MCP) joints. Synovitis and tenosynovitis were calculated based on the number of enhancing voxels, initial rate of enhancement, and maximal enhancement of gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). Periarticular bone erosion and bone edema were scored according to the OMERACT (Outcome Measures in Rheumatology Clinical Trials) scoring system in both groups. The degree of extracapsular Gd-DTPA enhancement was assessed in both conditions using semiquantitative scoring. No significant differences were seen in the volume of synovitis (P = 0.294), degree of flexor tenosynovitis (P = 0.532), periarticular erosions (P = 0.579), or degree of bone edema (P = 0.143) between RA and PMR joints. However, despite comparable degrees of synovitis, the proportion of MCP joints showing extracapsular enhancement was higher in the PMR group (100%) than in the RA group (50%) (P = 0.030). One PMR patient, but none of the RA patients, had bone edema at the capsular insertion. Despite degrees of synovitis and tenosynovitis comparable with those in RA, PMR-related hand disease is associated with prominent extracapsular changes, suggesting that inflammation in these tissues is more prominent than joint synovitis, which is common in both conditions. This suggests that the anatomic basis for joint disease localization differs between RA and PMR.

Detection of Chlamydia pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells.

Recent studies suggest that giant cell arteritis (GCA) may be an antigen-driven disease. Since Chlamydia pneumoniae has been identified in arterial vessel walls, it was hypothesized that this organism might be associated with GCA. Fourteen paraffin-embedded temporal artery biopsy specimens from 9 patients with GCA were examined by immunohistochemistry and by polymerase chain reaction (PCR) for the presence of C pneumoniae; for 5 patients, specimens were available from both the left and right arteries. Four temporal artery specimens from 3 patients with polymyalgia rheumatica (PMR) and 9 temporal artery specimens from 5 patients without GCA or PMR served as controls. C pneumoniae was detected by both immunohistochemistry and PCR in 6 GCA patient samples. One GCA patient sample was immunopositive only; another was PCR positive only. Thus, C pneumoniae was found in 8 of 9 GCA patients. One of 4 control samples from the PMR patients was immunopositive, but PCR negative, for C pneumoniae. The C pneumoniae-positive PMR patient also had respiratory symptoms. The remaining 9 control samples were negative for C pneumoniae by both immunohistochemistry and PCR. Immunohistochemistry showed that bacteria predominate in the adventitial layer of temporal arteries, in granulomatous infiltrates. Dendritic cells were examined by immunohistochemistry for their presence and localization in consecutive temporal artery specimens, and showed a strong topographic relationship with C pneumoniae. Like the bacterium, dendritic cells predominate in the adventitial layer of the arteries. C pneumoniae was found in temporal artery specimens from most GCA patients, in 1 specimen from a PMR patient, and in no other control specimens; thus, it may play a role in the pathogenesis of the disease. Dendritic cells may represent the antigen-presenting cells in this situation.

Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate: Comment on the article by Helfgott and Kieval

Arthritis & RheumatismVolume 40, Issue 9 p. 1725-1726 LetterFree to Read Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate: Comment on the article by Helfgott and Kieval L. Caliani MD, L. Caliani MD Hospital José M. Cullen, Santa Fe, ArgentinaSearch for more papers by this authorSergio O. Paira MD, Sergio O. Paira MD Hospital José M. Cullen, Santa Fe, ArgentinaSearch for more papers by this author L. Caliani MD, L. Caliani MD Hospital José M. Cullen, Santa Fe, ArgentinaSearch for more papers by this authorSergio O. Paira MD, Sergio O. Paira MD Hospital José M. Cullen, Santa Fe, ArgentinaSearch for more papers by this author First published: 12 December 2005 https://doi.org/10.1002/art.1780400929Citations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume40, Issue9September 1997Pages 1725-1726 RelatedInformation

Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate.

To ascertain the frequency of polymyalgia rheumatica (PMR) with a normal erythrocyte sedimentation rate (ESR; < or = 30 mm/hour) and to determine any defining clinical characteristics. A retrospective chart review study of all patients meeting the clinical criteria for PMR seen over a 5-year period in a hospital and an office-based rheumatology practice. We evaluated 117 patients; 26 (22.2%) had a pretreatment ESR of < or = 30 mm/hour (mean +/- SD 19.8 +/- 7.5 versus 74.4 +/- 30.3 mm/hour for elevated ESR group; P<0.0001). Of the 26 normal ESR patients, 15 (58%) were female compared with 74 of the 91 elevated ESR patients (81%) (P<0.02, by Fisher's exact test). The mean hemoglobin concentration was significantly lower in the elevated ESR population (mean +/- SD 1.23 +/- 0.15 gm/liter versus 1.38 +/- 0.11 gm/liter; P<0.0001). The duration of symptoms prior to treatment with prednisone was significantly longer for patients with a normal ESR (149 +/- 95 days versus 103 +/- 95 days for elevated ESR patients; P<0.04). In our series, PMR with a normal ESR accounted for approximately one-fifth of all PMR patients, more commonly in men. The lack of characteristically abnormal laboratory findings may result in a delay in the proper diagnosis and management of this condition.

Polymyalgia Rheumatica in Patients of Military Age

Polymyalgia Rheumatica in Patients of Military Age