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Polymyalgia rheumatica in 2011

Alessandra Soriano1, Raffaele Landolfi, Raffaele Manna

  • 1Clinical Autoimmunity Unit - Periodic Fever Research Centre, Catholic University of the Sacred Heart, L.go F. Vito N1, 00168 Rome, Italy.

Best Practice & Research. Clinical Rheumatology
|March 20, 2012
PubMed

Insights

Polymyalgia Rheumatica (PMR) is an inflammatory condition causing pain and stiffness in older adults. Management involves steroids, with potential side effects and resistance, necessitating steroid-sparing agents.

Area of Science:

  • Rheumatology
  • Immunology
  • Internal Medicine

Background:

  • Polymyalgia Rheumatica (PMR) is a common inflammatory rheumatic disease in individuals over 50.
  • It presents with shoulder and pelvic girdle pain and morning stiffness.
  • PMR can occur independently or alongside giant cell arteritis.

Purpose of the Study:

  • To review the clinical patterns, pathogenesis, and therapeutic strategies for Polymyalgia Rheumatica.
  • To highlight the role of imaging in identifying subclinical vasculitis.
  • To discuss management challenges including steroid side effects and resistance.

Main Methods:

  • Literature review of clinical presentations and imaging findings in PMR.
  • Analysis of pathogenetic factors including genetic and environmental influences.
  • Evaluation of current and emerging therapeutic approaches for PMR management.

Main Results:

  • Subclinical vasculitis is present in at least one-third of PMR patients, potentially leading to ischemic complications.
  • PMR is considered polygenic, with viral or bacterial triggers implicated in its pathogenesis.
  • Steroid therapy is effective but associated with side effects and potential glucocorticoid resistance.

Conclusions:

  • Optimizing PMR therapy may involve steroid-sparing agents.
  • Modified-release prednisone can be used for nighttime replacement therapy.
  • Understanding PMR's diverse clinical patterns and pathogenetic factors is crucial for effective management.

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