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Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica
Tanaz A Kermani1, Kenneth J Warrington2
1Division of Rheumatology, David Geffen School of Medicine, University of California Los Angeles, 2020 Santa Monica Boulevard, Suite 540, Santa Monica, CA 90404, USA.
Abstract:
Polymyalgia rheumatica (PMR) is a common inflammatory condition that often affects people over the age of 50 years. Characteristic symptoms are shoulder and hip girdle pain and prolonged morning stiffness. Markers of inflammation are often elevated. Clinicians are often faced with the challenge of distinguishing PMR from other conditions, particularly rheumatoid arthritis and spondyloarthropathy that can mimic symptoms of PMR in older people. Additionally, there is an association between PMR and giant cell arteritis, a common large-vessel vasculitis which also affects people over the age of 50 years. Imaging of the large vessels in asymptomatic patients with PMR often reveals findings of subclinical vasculitis. Presently, there are no tests that are specific for the diagnosis of PMR and clinicians rely on a combination of history, physical examination, laboratory tests and imaging studies to make a diagnosis. A recent undertaking by the European League Against Rheumatism/American College of Rheumatology has led to the publication of provisional classification criteria of PMR. Ultrasonography, which is being increasingly used by rheumatologists, can greatly aid in the diagnosis of PMR and often shows changes of synovitis and tenosynovitis. Treatment consists of low doses of glucocorticoids which are associated with morbidity. Evaluation of newer biologic therapies targeting inflammatory cytokines is underway. Despite treatment, relapses are common.
Insights
Polymyalgia rheumatica (PMR) is a common inflammatory condition in those over 50, causing pain and stiffness. Diagnosis relies on clinical factors, as specific tests are lacking, though ultrasonography shows promise.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is a prevalent inflammatory disorder affecting individuals over 50.
- Key symptoms include shoulder and hip girdle pain and significant morning stiffness.
- Elevated inflammatory markers are common, complicating differential diagnosis with conditions like rheumatoid arthritis.
Purpose of the Study:
- To review the diagnostic challenges and current understanding of Polymyalgia Rheumatica (PMR).
- To highlight the association between PMR and giant cell arteritis (GCA).
- To discuss recent advancements in diagnostic criteria and therapeutic approaches for PMR.
Main Methods:
- Review of clinical presentation, diagnostic workup, and epidemiological data for PMR.
- Analysis of the relationship between PMR and large-vessel vasculitis, including giant cell arteritis.
- Evaluation of emerging diagnostic tools like ultrasonography and provisional classification criteria.
Main Results:
- Distinguishing PMR from mimics like rheumatoid arthritis and spondyloarthropathy is a clinical challenge.
- Subclinical large-vessel vasculitis is often detected in asymptomatic PMR patients via imaging.
- Ultrasonography reveals synovitis and tenosynovitis, aiding PMR diagnosis.
Conclusions:
- Current PMR diagnosis relies on a combination of clinical assessment, labs, and imaging due to lack of specific tests.
- Provisional classification criteria have been developed by EULAR/ACR.
- Glucocorticoid treatment is standard but associated with morbidity; novel biologic therapies are under investigation, and relapses remain common.
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