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Diagnostic difficulties in polymyalgia rheumatica cases with normal erythrocyte sedimentation rate and C-reactive

Mete Kara1, Gülay Alp2, Ali Murat Koç3

  • 1University of Health Sciences Izmir Bozyaka Research and Training Hospital, Rheumatology Department, Izmir, Turkey.

Medicine
|September 29, 2023
PubMed

Insights

Polymyalgia Rheumatica (PMR) can present with normal erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. In these cases, elevated serum amyloid A (SAA) and bursitis confirmed by ultrasound aid diagnosis.

Area of Science:

  • Rheumatology
  • Internal Medicine
  • Diagnostic Medicine

Background:

  • Polymyalgia Rheumatica (PMR) diagnosis relies on clinical presentation due to lack of specific tests.
  • Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) are common acute-phase reactants (APRs) used in PMR diagnosis and monitoring.

Purpose of the Study:

  • To investigate the incidence of normal ESR and CRP in clinically diagnosed PMR patients.
  • To identify distinguishing clinical characteristics of PMR patients with normal ESR and CRP.

Main Methods:

  • Retrospective review of 54 clinically diagnosed PMR patients at a single center.
  • Ultrasonography used to confirm bursitis in patients with normal ESR and CRP.
  • Comparison of clinical features between PMR patients with normal versus elevated ESR/CRP levels.

Main Results:

  • 8 out of 54 (14%) PMR patients exhibited normal ESR and CRP levels.
  • All patients with normal ESR/CRP showed elevated Serum Amyloid A (SAA) levels.
  • PMR patients with normal ESR/CRP were younger at diagnosis, had longer symptom duration, and lower comorbidity rates.

Conclusions:

  • PMR diagnosis is possible even with normal ESR and CRP values.
  • Ultrasonography-confirmed bursitis is a key finding in these cases.
  • Elevated SAA levels can serve as an alternative biomarker when ESR and CRP are normal.

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