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Polymyalgia rheumatica without significantly increased erythrocyte sedimentation rate. A more benign syndrome
M A González-Gay1, V Rodríguez-Valverde, R Blanco
1Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain.
Background:
An erythrocyte sedimentation rate (ESR) of at least 40 mm/h is considered an important requisite for the diagnosis of polymyalgia rheumatica (PMR). However, the relative frequency and clinical features of PMR in patients without a significantly increased ESR are unclear.
Methods:
We performed a retrospective study of patients diagnosed as having PMR at the rheumatology divisions of 3 teaching hospitals. The diagnosis of PMR was established, regardless of the ESR, in 201 consecutive patients fulfilling the following criteria: (1) age 50 years or older, (2) severe proximal pain for more than 1 month in at least 2 of 3 areas: neck, shoulder, and/or pelvic girdles, and (3) rapid resolution of the syndrome while taking low-dose prednisone. Patients with giant cell arteritis were previously excluded from the study. The frequency and clinical features of patients with PMR and an ESR lower than 40 mm/h were analyzed. A comparative study between these patients and those with high ESRs was performed.
Results:
An ESR lower than 40 mm/h was found in 41 patients (20.4%). These patients were younger (P = .02), were more frequently men (P = .006), and experienced a lower frequency of fever (P = .003) and weight loss (P = .07). Furthermore, these patients were characterized by an absence of anemia (P = .002) and a lower frequency of abnormal protein electrophoresis results (P < .001). Otherwise, their clinical syndrome, response to therapy, and frequency of relapses were similar to those of patients with classic PMR. In the entire population of 201 patients, the ESR was related to the length of treatment, number of areas involved, presence of fever, weight loss, and laboratory test result abnormalities, but it was unrelated to the duration of the illness prior to diagnosis.
Conclusions:
It is not uncommon to find a patient with PMR with an ESR lower than 40 mm/h. This syndrome is more frequent in men and it is clinically less severe than the classic form of PMR. Its recognition will allow these patients to benefit from an effective treatment with low-dose corticosteroids.
Insights
Polymyalgia rheumatica (PMR) can occur with a normal erythrocyte sedimentation rate (ESR). This less severe form is more common in men and benefits from low-dose corticosteroid treatment.
Area of Science:
- Rheumatology
- Internal Medicine
Background:
- The erythrocyte sedimentation rate (ESR) is a key diagnostic marker for polymyalgia rheumatica (PMR).
- The clinical characteristics and prevalence of PMR in patients with a normal ESR are not well-defined.
Purpose of the Study:
- To investigate the frequency and clinical features of PMR in patients with an ESR below 40 mm/h.
- To compare these patients with those diagnosed with classic PMR and a high ESR.
Main Methods:
- Retrospective analysis of 201 consecutive patients diagnosed with PMR across three teaching hospitals.
- PMR diagnosis was based on age (≥50), proximal pain in specific areas, and rapid response to low-dose prednisone, irrespective of ESR.
- Patients with giant cell arteritis were excluded.
Main Results:
- 41 patients (20.4%) presented with PMR and an ESR < 40 mm/h.
- These patients were younger, more frequently male, and had fewer systemic symptoms like fever and weight loss.
- Absence of anemia and fewer abnormal protein electrophoresis results were noted in the low ESR group, though clinical presentation and treatment response were similar to classic PMR.
Conclusions:
- PMR can occur in patients with an ESR lower than 40 mm/h, a finding not uncommon.
- This variant of PMR is more prevalent in men and presents with milder clinical symptoms.
- Early recognition allows timely treatment with low-dose corticosteroids, improving patient outcomes.