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Polymyalgia rheumatica: diagnosis and treatment
Martin Soubrier1, Jean-Jacques Dubost, Jen-Michel Ristori
1Service de Rhumatologie, CHU de Clermont-Ferrand, place Henri-Dunant, BP 69, 63003 Clermont-Ferrand cedex 1, France. msoubrier@chu-clermontferrand.fr
Joint Bone Spine
|November 23, 2006
Summary
Polymyalgia rheumatica (PMR) can be overdiagnosed, as other serious conditions may mimic its symptoms. Early diagnosis and appropriate treatment are crucial, as PMR can indicate underlying diseases like giant cell arteritis or malignancy.
Area of Science:
- Rheumatology
- Internal Medicine
- Diagnostic Medicine
Background:
- Polymyalgia rheumatica (PMR) is characterized by inflammatory pain in the shoulder and/or pelvic girdles in individuals over 50.
- Historically underrecognized, PMR is now potentially overdiagnosed, necessitating careful differential diagnosis.
- PMR can be an early sign of serious conditions, including giant cell arteritis, malignancy, or infection.
Purpose of the Study:
- To highlight the diagnostic challenges and potential mimics of polymyalgia rheumatica.
- To emphasize the importance of a thorough evaluation to rule out more severe underlying pathologies.
- To discuss current understanding of PMR diagnosis and treatment.
Main Methods:
- Review of clinical manifestations and differential diagnoses of PMR.
- Discussion of diagnostic aids such as ultrasonography.
- Analysis of treatment strategies including glucocorticoids and other medications.
Main Results:
- Numerous conditions can simulate PMR, ranging from other rheumatologic diseases to endocrine disorders, malignancies, and infections.
- Failure to respond to glucocorticoids warrants investigation for giant cell arteritis, malignancy, or infection.
- Ultrasonography can aid diagnosis, particularly by identifying bilateral subdeltoid bursitis.
Conclusions:
- Physicians must maintain a high index of suspicion for conditions mimicking PMR.
- A comprehensive search for associated signs is mandatory when PMR is suspected.
- Glucocorticoids remain the primary treatment, with low-dose initiation and slow tapering potentially reducing relapse rates; methotrexate may be useful for glucocorticoid-dependent cases.
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