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[Polymyalgia rheumatica: What's new?]
1Klinik für Innere Medizin, Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin-Buch, Deutschland.
Abstract:
Currently, only 25% of all polymyalgia rheumatica (PMR) patients are referred to specialists. An expert committee has recently recommended confirmation of diagnosis by specialist care. This can help to avoid misdiagnoses and hospital stays and can result in lower glucocorticoid doses.Using ultrasound, magnetic resonance imagining (MRI), or positron emission tomography-computed tomography (PET-CT), typical periarticular inflammatory changes are observed, especially in the shoulder and pelvic girdle area. However, for clinical use, ultrasound is usually sufficient.In 20-25% of newly diagnosed PMR patients without symptoms of giant cell arteritis (GCA), GCA can be detected through vascular ultrasound. These patients require higher glucocorticoid doses in analogy to GCA therapy. There is growing awareness of a joint GCA-PMR spectrum disease.Glucocorticoids remain the primary treatment. The interleukin-6 inhibitor Sarilumab has recently been approved in the USA for patients with recurrent PMR. Studies have also demonstrated the effectiveness of Tocilizumab in PMR.
Insights
Specialist diagnosis improves polymyalgia rheumatica (PMR) care, reducing misdiagnosis and hospitalizations. Advanced imaging and new treatments like Sarilumab offer better management for PMR and related giant cell arteritis (GCA).
Area of Science:
- Rheumatology
- Medical Imaging
- Pharmacology
Context:
- Polymyalgia rheumatica (PMR) diagnosis is often delayed, with only 25% of patients seeing specialists.
- Expert recommendations emphasize specialist confirmation to prevent misdiagnosis and reduce glucocorticoid dependency.
- PMR shares inflammatory characteristics with giant cell arteritis (GCA), necessitating careful diagnostic evaluation.
Purpose:
- To highlight the importance of specialist diagnosis in polymyalgia rheumatica (PMR).
- To discuss the role of imaging modalities like ultrasound in diagnosing PMR and detecting co-existing giant cell arteritis (GCA).
- To review current and emerging therapeutic strategies for PMR management.
Summary:
- Specialist care improves PMR diagnosis, potentially lowering glucocorticoid doses and hospitalizations.
- Imaging techniques, particularly ultrasound, are crucial for identifying characteristic inflammatory changes and detecting subclinical GCA in PMR patients.
- While glucocorticoids remain primary, targeted therapies like Sarilumab and Tocilizumab show promise for recurrent or refractory PMR.
Impact:
- Enhanced diagnostic accuracy for PMR, leading to more appropriate and timely treatment.
- Improved patient outcomes through reduced misdiagnosis, optimized glucocorticoid use, and effective targeted therapies.
- Recognition of the GCA-PMR spectrum disease fosters a more integrated approach to managing these related inflammatory conditions.
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