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Musculoskeletal manifestations in polymyalgia rheumatica and temporal arteritis
J Narváez1, J M Nolla-Solé, J A Narváez
1Department of Rheumatology, Hospital Príncipes de España, Ciudad Sanitaria y Universitaria de Bellvitge, Barcelona, Spain. med022409@nacom.es
Objective:
To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA).
Methods:
The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations.
Results:
Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed.
Conclusion:
The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests different mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression.
Insights
Distal musculoskeletal symptoms are common in polymyalgia rheumatica (PMR) but rare in temporal arteritis (TA). This suggests distinct disease mechanisms for PMR and TA, potentially indicating separate conditions.
Area of Science:
- Rheumatology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) and temporal arteritis (TA) are inflammatory conditions often presenting with musculoskeletal symptoms.
- Understanding the specific manifestations in each condition is crucial for accurate diagnosis and management.
Purpose of the Study:
- To investigate the incidence and characteristics of musculoskeletal manifestations in patients diagnosed with PMR and TA.
- To differentiate the typical presentations of PMR and TA.
Main Methods:
- A retrospective review of 163 patient records diagnosed with PMR or TA over 15 years in Spain.
- Analysis focused on the presence and type of musculoskeletal symptoms.
Main Results:
- 20% of isolated PMR patients developed mild, transient distal peripheral arthritis, carpal tunnel syndrome, or extremity swelling, always with active PMR.
- PMR occurred in 56% of TA patients, but only 11% of TA patients had peripheral arthritis, which was linked to concurrent PMR.
- Distal extremity swelling or polyarthritis were not observed in pure TA patients.
Conclusions:
- The distal musculoskeletal manifestations in PMR align with previous reports.
- Distal symptoms are infrequent in TA, suggesting different underlying disease mechanisms.
- Findings support viewing PMR and TA as separate conditions or a single disease with variable clinical expression based on host factors.