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The pathophysiology of polymyalgia rheumatica, small pieces of a big puzzle

Guillermo Carvajal Alegria1, Sara Boukhlal2, Divi Cornec1

  • 1Univ Brest, Inserm, CHU de Brest, LBAI, UMR1227, Brest, France; Service de Rhumatologie, Centre de Référence Maladies Autoimmunes Rares CERAINO, CHU Cavale Blanche, Brest, France.

Autoimmunity Reviews
|September 17, 2020
PubMed

Insights

Polymyalgia rheumatica (PMR) is a common condition in those over 50. Recent research highlights aging, B cell changes, and IL-6

Area of Science:

  • Rheumatology
  • Immunology
  • Gerontology

Background:

  • Polymyalgia rheumatica (PMR) is a prevalent rheumatic disease affecting individuals over 50.
  • While often linked to giant cell arteritis (GCA), PMR can occur independently.
  • The underlying pathophysiology of PMR remains incompletely understood.

Purpose of the Study:

  • To synthesize current knowledge on PMR pathophysiology.
  • To review data from genetic, immunogenetic, immunologic, antibody, and aging studies.
  • To identify gaps in current understanding and suggest future research directions.

Main Methods:

  • Literature review of existing studies on PMR pathophysiology.
  • Analysis of data related to genetics (HLA system, HLA-DRB1), immunogenetics (interleukins like IL-6), and immunology (CD8+ T cells, B cell homeostasis).
  • Inclusion of recent findings on the role of aging and cellular infiltration.

Main Results:

  • Established associations include the HLA-DRB1 gene and elevated IL-6 levels.
  • Recent studies reveal the significance of B cell homeostasis disturbances and IL-6 secretion by the innate immune system.
  • Aging emerges as a critical factor, potentially influencing susceptibility to infections, immune modulation, and hormonal changes.

Conclusions:

  • PMR pathophysiology involves complex interactions including genetic predisposition, immune dysregulation, and the aging process.
  • Further research is needed to elucidate the role of cellular infiltration around joints.
  • Understanding these factors is crucial for developing effective therapeutic strategies for PMR.
Keywords:
AgingB cellHLA-DRInterleukin-6Polymyalgia rheumaticaT cell

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