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Recent advances in the diagnosis and treatment of polymyalgia rheumatica
Francesco Muratore1, Giulia Pazzola1, Nicolò Pipitone1
1a Rheumatology Unit, Department of Internal Medicine , Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico , Reggio Emilia , Italy.
Introduction:
Polymyalgia rheumatica is one of the most common rheumatic inflammatory disorders in people older than 50 years characterized by aching and prolonged morning stiffness in the shoulder and pelvic girdle and neck..
Areas Covered:
In this review, we will focus on recent advances on the diagnosis and management of PMR. Expert commentary: Controversy exist whether PMR represent a single entity disease or is an umbrella term that comprises a clinical presentation common to a range of related conditions (polymyalgic syndrome). To date there are no specific diagnostic tests, and the diagnosis remains clinical, although ultrasonography, positron emission tomography scan and the recent ACR/EULAR classification criteria may help to confirm the clinical diagnosis. A step-wise process for the diagnosis of PMR has been proposed. Low-dose steroids are highly effective in the majority of patients and remain the mainstay of treatment, but relapses occur in about 50% of patients and glucocorticoid related adverse event are common. The steroid sparing effects of the immunosuppressive treatment evaluated to date are unclear.
Insights
Polymyalgia rheumatica (PMR) diagnosis remains clinical, though imaging and criteria aid confirmation. Low-dose steroids are effective but relapses and side effects are common, with unclear benefits of steroid-sparing treatments.
Area of Science:
- Rheumatology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) is a prevalent inflammatory rheumatic disorder affecting individuals over 50.
- Characterized by shoulder, pelvic girdle, and neck pain with morning stiffness.
Purpose of the Study:
- To review recent diagnostic and management advancements for polymyalgia rheumatica.
- To discuss the ongoing debate regarding PMR as a distinct entity versus a syndrome.
Main Methods:
- Review of current literature on PMR diagnosis and treatment.
- Focus on diagnostic aids like ultrasonography, PET scans, and ACR/EULAR criteria.
- Evaluation of steroid efficacy and steroid-sparing treatments.
Main Results:
- Diagnosis of PMR is primarily clinical, with no specific diagnostic tests.
- Imaging modalities and classification criteria can support clinical diagnosis.
- Low-dose corticosteroids are the primary treatment, achieving high efficacy but associated with frequent relapses (approx. 50%) and adverse events.
- The efficacy of steroid-sparing immunosuppressive treatments remains uncertain.
Conclusions:
- A step-wise diagnostic approach for PMR is recommended.
- While steroids are effective, managing relapses and adverse effects is crucial.
- Further research is needed to clarify the role and efficacy of steroid-sparing agents in PMR management.
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