[Therapy of rheumatic polymyalgia: the pathophysiologic management]

Area of Science:

• Rheumatology
• Endocrinology
• Immunology

Background:

• Polymyalgia rheumatica (PMR) is an increasingly prevalent inflammatory syndrome in the elderly.
• Ageing and chronic stress may impair the hypothalamic-pituitary-adrenal (HPA) axis, contributing to PMR pathogenesis.
• PMR is characterized by synovitis, vasculitis, and heightened inflammatory markers, including cytokines and altered steroidal hormones.

Discussion:

• The HPA axis suppression and endocrine senescence in the elderly, exacerbated by chronic stress, compromise endogenous glucocorticoid production.
• Glucocorticoids are the primary treatment for active PMR, acting as a temporary replacement therapy.
• Modified-release glucocorticoids may optimize PMR treatment by mimicking physiological circadian rhythms, potentially reducing side effects.

Key Insights:

• PMR pathogenesis involves HPA axis dysfunction and chronic stress in the aging population.
• Intensive inflammatory reactions are indicated by serum cytokine and steroidal hormone patterns in PMR patients.
• Glucocorticoid therapy is crucial for managing active PMR, with potential for improved outcomes using modified-release formulations.

Outlook:

• Further research into modified-release glucocorticoids could enhance PMR treatment efficacy and safety.
• Combination therapy with glucocorticoids and pro-inflammatory cytokine inhibitors warrants investigation in large-scale PMR studies.
• Early intervention and tailored therapeutic strategies are essential for managing PMR effectively.