Objective-To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA). Methods-The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations. Results-Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed. Conclusion-The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests diVerent mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression. (Ann Rheum Dis 2001;60:1060-1063 There is controversy as to whether polymyalgia rheumatica (PMR) and temporal arteritis (TA) are expressions of the same disease or are two diVerent, partly overlapping, diseases. PMR is a common syndrome of the elderly characterised by pain and stiVness involving the neck, shoulder and pelvic girdles, generally accompanied by constitutional symptoms and a raised erythrocyte sedimentation rate. The cause of musculoskeletal pain in PMR is not completely understood, but inflammation in proximal joints and periarticular structures is a likely basis for much of the discomfort since, to date, there is little evidence to suggest that the musculoskeletal symptoms are related to underlying vasculitis. Evidence of proximal articular and periarticular synovitis has been demonstrated by scanning, MRI, arthroscopy, and synovial biopsy. 1-3Moreover, an increasing number of reports have underlined the presence of peripheral synovitis and other distal musculoskeletal manifestations in PMR, suggesting that the spectrum of musculoskeletal involvement in this entity is not completely defined and is broader than has often been thought previously. [4][5][6][7][8] The clinical predominance of proximal symptoms in PMR has probably overshadowed...

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The aim of the study was to assess the prevalence of moderate to severe psoriasis (MS-P) in patients with psoriatic arthritis (PsA) and the relationship between MS-P and other variables related to arthritis. One hundred sixty-six consecutive patients with PsA periodically monitored at a university hospital's PsA unit in northeastern Spain were included in the study. Patients with psoriasis were classified as having MS-P when systemic treatment for skin was required. Clinical criteria for treatment indication was BSA >10 and/or PASI >14 and/or psoriasis affecting a very sensitive area of the body. Demographic and clinical data related to arthritis were assessed, including PsA pattern, age of onset of psoriasis and arthritis, disease activity index, and treatment required over the course of the disease. Moderate-severe psoriasis were more prevalent in women (p = 0.027). One hundred nine patients (65.7%) had psoriatic nail disease, and MS-P was more frequent in these patients (40 (77%) vs. 69 (61%), p = 0.028). Patients with spondyloarthropathy were significantly associated with MS-P (7 (16%) vs. 3 (3%), p = 0.014). No statistical association was observed between severe psoriasis and the age of onset of psoriasis or arthritis, involvement of distal interphalangeal joints, laboratory findings (HLA B27, RF), functional class, or disease activity indices. We report a high prevalence of severe psoriasis among patients with psoriatic arthritis, higher in women and patients with psoriatic nail disease and axial spondyloarthropathy.

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