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The clinical course of polymyalgia rheumatica in Chinese
Wai Ling Li1, Yi Lo, Moon Ho Leung
1Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China.
Abstract:
Polymyalgia rheumatica (PMR) is diagnosed based on clinical features that may overlap with other rheumatic conditions like rheumatoid arthritis (RA). Furthermore, a proportion of PMR patients may subsequently evolve into RA. The aim of this study was to examine the clinical characteristics of PMR patients in a Chinese cohort compared to a Caucasian series. Patients diagnosed to have PMR during 1997-2008 were reviewed for clinical features and compared to a reported Caucasian series. Rheumatoid factor (RF) and anticyclic citrullinated peptide (CCP) antibodies were determined by immunonephelometry and enzyme-linked immunosorbent assay, respectively. Forty-four patients of southern Chinese origin were diagnosed to have PMR according to specialist opinion. Seventy-five percent of patients (n = 33) were >65 years of age at diagnosis (mean +/- standard deviation, 75.8 +/- 9.6 years). The commonest feature at disease onset was elevated erythrocyte sedimentation rate >40 mm/h (100% vs. 95.7%; p = 0.17) and bilateral shoulder pain or stiffness (95.5% vs. 90.8%; p = 0.31), comparable in frequency to the Caucasian cohort. However, Chinese patients had significantly longer duration of symptoms before diagnosis (p < 0.001) but less bilateral upper arm tenderness (p < 0.001) and generalized stiffness (p = 0.01). Twelve (27.3%) patients evolved into RA after a median duration of 2 months from onset of PMR. RF and anti-CCP antibodies were positive in 66.7% and 60% of these patients compared to 9.4% and 6.2%, respectively, among those who did not evolve into RA during the period observed. Chinese patients with PMR have modestly different clinical profile compared to the Caucasian counterpart. RF and anti-CCP antibodies were more likely to be present in those who subsequently developed into RA.
Insights
Polymyalgia rheumatica (PMR) in Chinese patients shows distinct clinical features compared to Caucasian cohorts, with a higher rate of evolving into rheumatoid arthritis (RA). Early detection of rheumatoid factor (RF) and anti-CCP antibodies aids in predicting this progression.
Area of Science:
- Rheumatology
- Clinical Immunology
- Epidemiology
Background:
- Polymyalgia rheumatica (PMR) diagnosis can be challenging due to overlapping symptoms with other rheumatic diseases, such as rheumatoid arthritis (RA).
- A subset of PMR patients may transition to RA, necessitating a deeper understanding of differentiating factors.
- Ethnic variations in disease presentation and progression are increasingly recognized in rheumatological conditions.
Purpose of the Study:
- To compare the clinical characteristics of Polymyalgia Rheumatica (PMR) in a Chinese cohort with those reported in a Caucasian series.
- To investigate the frequency and predictors of PMR evolving into Rheumatoid Arthritis (RA) within the Chinese cohort.
Main Methods:
- Retrospective review of 44 southern Chinese patients diagnosed with PMR between 1997 and 2008.
- Comparison of clinical features, including symptom duration and specific pain/stiffness patterns, against a published Caucasian cohort.
- Determination of Rheumatoid Factor (RF) and anti-Cyclic Citrullinated Peptide (CCP) antibodies using immunonephelometry and ELISA, respectively.
Main Results:
- Chinese PMR patients presented with a significantly longer duration of symptoms before diagnosis compared to Caucasian counterparts.
- Chinese patients exhibited less bilateral upper arm tenderness and generalized stiffness but comparable rates of elevated ESR and shoulder pain/stiffness.
- 27.3% of Chinese PMR patients evolved into RA, with a higher prevalence of positive RF and anti-CCP antibodies in those who progressed.
Conclusions:
- Chinese patients with PMR demonstrate a subtly different clinical profile compared to Caucasians, particularly regarding symptom duration and specific tenderness patterns.
- The evolution of PMR into RA is observed in a significant proportion of Chinese patients, underscoring the importance of monitoring.
- Presence of RF and anti-CCP antibodies is a key indicator for PMR patients at higher risk of developing RA.
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