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Polymyalgia rheumatica with normal inflammatory indices at the time of diagnosis: can we just move a step forward?

Ciro Manzo1, Marcin Milchert2, Maria Natale1

  • 1Internal and Geriatric Medicine Department, Rheumatologic Outpatient Clinic Hospital "Mariano Lauro", Sant'Angello, Italy.

Reumatologia
|July 21, 2020
PubMed

Insights

Polymyalgia rheumatica (PMR) can occur with normal inflammatory markers, particularly in patients treated with immune checkpoint inhibitors. This suggests upstream pathogenic mechanisms involving immune checkpoints in a subset of PMR cases.

Area of Science:

  • Rheumatology
  • Immunology
  • Oncology

Background:

  • Polymyalgia rheumatica (PMR) diagnosis is challenged by cases with normal inflammatory indices.
  • Immune checkpoint inhibitors (ICIs) are associated with PMR in some patients, presenting with normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Purpose of the Study:

  • To investigate the role of immune checkpoint inhibition in PMR pathogenesis.
  • To explore whether PMR in this context represents a distinct subset or a PMR-like syndrome.

Main Methods:

  • Review of literature on PMR associated with ICI therapy.
  • Analysis of potential pathogenetic mechanisms involving immune checkpoints like PD-1, PD-L1, and CTLA-4.

Main Results:

  • Some PMR cases, especially post-ICI, exhibit normal inflammatory markers (ESR, CRP).
  • Inhibition of immune checkpoints (PD-1, PD-L1, CTLA-4) may represent an upstream pathogenetic mechanism in these patients.

Conclusions:

  • PMR may have a subset driven by immune checkpoint dysregulation.
  • This immune checkpoint-driven mechanism could explain PMR with normal inflammatory indices.
Keywords:
checkpoint inhibitorscheckpoint inhibitory therapyinflammatory indicespolymyalgia rheumatica

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