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Update on polymyalgia rheumatica
Nicolò Pipitone1, Carlo Salvarani
1Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
Insights
Polymyalgia rheumatica is an inflammatory condition primarily affecting older adults, causing pain and stiffness. It often responds well to glucocorticoids but may require long-term management.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is an inflammatory disease of unknown cause.
- It predominantly affects Caucasians over 50 and is linked to giant cell arteritis.
- Females are disproportionately affected, being two to three times more susceptible than males.
Purpose of the Study:
- To describe the key characteristics of polymyalgia rheumatica.
- To highlight its association with other conditions and typical patient demographics.
- To outline the diagnostic indicators and treatment responses.
Main Methods:
- Clinical observation and analysis of patient demographics.
- Review of diagnostic criteria and imaging findings.
- Assessment of treatment outcomes with glucocorticoids and other agents.
Main Results:
- Hallmark symptoms include shoulder, pelvic girdle, and neck aching and morning stiffness.
- Elevated serum inflammatory markers and bursitis on imaging are common.
- A significant and rapid response to glucocorticoid therapy is characteristic.
Conclusions:
- Polymyalgia rheumatica is a distinct inflammatory condition with characteristic clinical and laboratory features.
- Glucocorticoids are the primary treatment, with many patients achieving remission.
- Long-term management may be necessary for some, and glucocorticoid-sparing agents can be beneficial.
Abstract:
Polymyalgia rheumatica is an inflammatory disease of unknown etiology affecting individuals aged fifty years and older, mainly of Caucasian ethnicity. Polymyalgia rheumatica is associated with giant cell arteritis more frequently than expected by chance alone. In both conditions, females are affected two to three times more often than males. The clinical hallmark manifestations of polymyalgia rheumatica are aching and morning stiffness in the shoulder girdle and often in the pelvic girdle and neck. Serum inflammatory markers are typically elevated, while the most consistent abnormal finding on imaging studies is bursitis in the symptomatic areas. A dramatic response to glucocorticoids is characteristic of polymyalgia rheumatica. Many patients are able to discontinue glucocorticoids six months to two years after the onset of clinical symptoms, but some patients may require longstanding glucocorticoid treatment. Glucocorticoid-sparing agents may be helpful in patients with chronic relapsing courses and those at high risk of glucocorticoid-related adverse events.
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