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Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
1Division of Rheumatology, Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA.
Objectives:
The diagnostic diversity of polymyalgia rheumatica (PMR) can easily be obscured by the widespread use of corticosteroids (CSs) early in the disease course. This study observed the course of PMR without CSs and determined whether alternative medication could be useful.
Methods:
Seventy patients with new-onset PMR comprised phase 1. Eight were removed with specific diagnoses (four with giant cell arteritis [GCA]). The remaining 62 were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone until enough time had elapsed to ascertain whether their PMR had evolved into another rheumatologic inflammatory condition. Hydroxychloroquine (HCQ) was then added to their regimen. Twenty-five additional patients with PMR comprised phase 2. Twenty-two were immediately treated with HCQ prior to the anticipated disease progression.
Results:
In phase 1, 52/62 developed synovitis in multiple other joints 9 months from PMR onset; 48/52 received HCQ, and 42/48 (87.5%) achieved complete remission. In phase 2, during HCQ induction, 21 patients developed similar synovitis; after 6 months of HCQ use, 80% achieved remission. In 73/95 (77%), a definite diagnosis of rheumatoid arthritis (RA) could be made on average 8.5 months from PMR onset. Only 12/95 (13%) stayed true to form with their PMR and did not develop another specific diagnosis.
Conclusion:
In this study, true PMR was infrequent in the absence of GCA. PMR in most patients evolved into seronegative RA, which was dramatically responsive to HCQ use. Treatment of acute PMR with HCQ was a rational alternative to CS use even if progressive additive synovitis had not yet occurred.
Insights
Polymyalgia rheumatica (PMR) often evolves into rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) effectively treated PMR patients who developed RA, offering an alternative to corticosteroids.
Area of Science:
- Rheumatology
- Internal Medicine
Background:
- Polymyalgia rheumatica (PMR) diagnosis can be challenging due to early corticosteroid (CS) use.
- Observing PMR without CSs is crucial for accurate diagnosis and treatment.
Purpose of the Study:
- To investigate the natural course of PMR without CS treatment.
- To evaluate the efficacy of alternative medications, specifically hydroxychloroquine (HCQ), for PMR.
Main Methods:
- Seventy new-onset PMR patients were initially assessed; 8 were excluded (4 with giant cell arteritis).
- 62 patients received NSAIDs, later adding HCQ. 25 additional patients started HCQ early.
- Disease progression and response to HCQ were monitored.
Main Results:
- 52/62 patients developed synovitis, with 87.5% achieving remission after HCQ.
- In phase 2, 80% of patients achieved remission with HCQ.
- 77% of patients were ultimately diagnosed with seronegative rheumatoid arthritis (RA) within 8.5 months.
Conclusions:
- True PMR is rare without giant cell arteritis (GCA).
- PMR frequently progresses to seronegative RA, which responds well to HCQ.
- HCQ is a viable alternative to CS for managing PMR, even before advanced synovitis appears.
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