[Polymyalgia rheumatica: new developments and challenges]

Area of Science:

• Rheumatology
• Internal Medicine

Background:

• Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder characterized by elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.
• PMR diagnosis presents challenges due to its arbitrary nature and potential for normal inflammatory marker values.
• Current diagnostic approaches for PMR are primarily clinical, with imaging modalities reserved for complex cases.

Purpose of the Study:

• To review the diagnostic and therapeutic landscape of polymyalgia rheumatica.
• To discuss the role of imaging in PMR diagnosis.
• To explore current and emerging treatment strategies for PMR.

Main Methods:

• Literature review of diagnostic criteria and treatment outcomes for polymyalgia rheumatica.
• Analysis of the utility of imaging techniques (echography, MRI, FDG-PET/CT) in PMR diagnosis.
• Evaluation of evidence for glucocorticoid and steroid-sparing therapies in PMR management.

Main Results:

• Inflammation markers (ESR, CRP) are often elevated in PMR but not always, complicating diagnosis.
• Glucocorticoids are the mainstay of PMR treatment, with variable response times and typical treatment durations of 1-3 years.
• Methotrexate shows the most evidence among steroid-sparing agents, with limited data on azathioprine, leflunomide, and promising but preliminary results for tocilizumab.

Conclusions:

• PMR diagnosis requires careful clinical assessment, potentially aided by imaging in ambiguous cases.
• Glucocorticoid therapy is effective but associated with long treatment courses and potential side effects.
• Further research is needed to establish the efficacy and safety of steroid-sparing agents, including tocilizumab, for long-term PMR management.