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[Rheumatic polymyalgia]
J M Calvo Romero1, J L Ramos Salado, M Pérez Miranda
1Servicio de Medicina Interna, Centro Hospital Regional Universitario Infanta Cristina, Badajoz.
Abstract:
Polymyalgia rheumatica (PMR) is a common clinical syndrome that is characterized by pain and stiffness in neck, shoulder girdle and pelvic girdle. The aetiology is unknown. However, recent studies have documented an association with HLA antigens and infectious agents. It occurs mostly after the age of 50 years and is often accompanied by systemic features such as fever, asthenia, hyporexia and weight loss. An erythrocyte sedimentation rate (ESR) of at least 40 mm/hour has been considered diagnostic criterion. Nevertheless, a normal ESR accounted for up to 20% of cases of PMR. A dramatic and prompt response to corticosteroid treatment is characteristic. Giant cell arteritis/temporal arteritis (GCA) has been found in 0-80% of cases of PMR. Temporal biopsy could initially be deferred in patients with PMR younger than 70 years with no cranial symptoms, in which the risk of GCA is very low.
Insights
Polymyalgia rheumatica (PMR) is a common inflammatory condition causing pain and stiffness, primarily diagnosed by elevated erythrocyte sedimentation rate (ESR) and response to corticosteroids. Diagnosis can be challenging as some patients present with normal ESR levels.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Immunology
Background:
- Polymyalgia rheumatica (PMR) is a prevalent clinical syndrome affecting individuals over 50.
- Characterized by pain and stiffness in the neck, shoulder, and pelvic girdles.
- Often presents with systemic symptoms like fever, fatigue, and weight loss.
Purpose of the Study:
- To review the diagnostic criteria and clinical features of Polymyalgia Rheumatica (PMR).
- To discuss the association of PMR with HLA antigens and infectious agents.
- To highlight the relationship between PMR and Giant Cell Arteritis (GCA).
Main Methods:
- Literature review of recent studies on PMR.
- Analysis of diagnostic criteria including erythrocyte sedimentation rate (ESR).
- Evaluation of the response to corticosteroid treatment.
Main Results:
- PMR diagnosis is supported by an ESR of at least 40 mm/hour, though up to 20% of cases may have normal ESR.
- A rapid and significant response to corticosteroid therapy is a hallmark of PMR.
- Giant Cell Arteritis (GCA) is found in 0-80% of PMR cases; temporal biopsy may be deferred in younger patients without cranial symptoms.
Conclusions:
- PMR diagnosis requires careful consideration of clinical symptoms, ESR, and response to treatment.
- The association with GCA necessitates vigilance, but diagnostic approaches can be tailored based on patient age and symptoms.
- Further research into the etiology, potentially involving HLA antigens and infections, is warranted.