Clinical Features, Treatment and Monitoring in Patients With Polymyalgia Rheumatica

Abstract

Objectives:This study aims to evaluate the clinical symptoms and laboratory findings of Turkish patients with polymyalgia rheumatica. Patients and methods: Clinical data of 41 patients (9 males, 32 females; mean age 65.5±7.6 years; range 60 to 80 years) with polymyalgia rheumatica were retrospectively evaluated. Patients' clinical symptoms, laboratory findings, therapies and therapeutic responses were analyzed. Results: The most common symptoms were bilateral shoulder pain (59.9%) and morning stiffness (48.78%). Mean erythrocyte sedimentation rate at diagnosis was 66.8±22.5 mm/h, while mean C-reactive protein value was 48.7±25.8 mg/dL. In the third week of corticosteroid treatment, good response to treatment was detected in 33 patients (80.5%). Mean age of patients who gave good response to treatment (67.2±6.7) was higher than mean age of patients who gave poor or no response to treatment (58.5±7.8) (p=0.009). Conclusion: Patients' clinical features, laboratory findings, initial steroid doses, and responses to corticosteroid therapy were consistent with the literature. However, the rate of morning stiffness was high and peripheral arthritis was rare. Giant cell arteritis was not detected in patients with polymyalgia rheumatica. Good response to early steroid treatment was observed in older patients. Rate of relapse was low. Further studies are required to evaluate factors affecting response to treatment, remission, and relapse.

Isolated polymyalgia rheumatica: a cross-sectional, single-center, retrospective cohort study

“…25 A retrospective study conducted in Turkey with a one-year follow-up of 41 patients, reported that 80.5% of patients responded well to corticosteroid treatment at the 3rd-week outpatient follow-up evaluation. 26 Our study determined that while approximately half of the patients were in remission at the first and second outpatient follow-up evaluations, this rate decreased at the third evaluation. At the final outpatient follow-up evaluation, the goal of remission was achieved in approximately one-third of the patients.…”

Ревматическая Полимиалгия: Объединяя Усилия Европейских Ревматологических Обществ

“…The guidelines under discussion [6] emphasize the lack of PMR etiology and pathogenesis studies and such possible RFs of its development as genetic, infectious, immune and vascular ageing-related factors, endocrine disorders. According to С. Dejaco and F. Muratore et al (2016) [8,15], there may be suggested an association between the more pronounced systemic, articular and periarticular inflammation symptoms and a history of vasculitis. The systematic review by F. [7] reports a more common PMR clinical symptom being the bilateral shoulder pain (95 %), "other typical symptoms" being an acute or sub-acute pain in the neck and pelvic girth, as well as the morning constrain, and "possible manifestations" being arthritides and tenosynovitides of proximal (shoulder, coxofemoral) and distal (hand, knee) joints, as well as constitutional manifestations -fever, reduced appetite, weakness and/or loss of weight [8,14].…”

“…The systematic review by F. [7] reports a more common PMR clinical symptom being the bilateral shoulder pain (95 %), "other typical symptoms" being an acute or sub-acute pain in the neck and pelvic girth, as well as the morning constrain, and "possible manifestations" being arthritides and tenosynovitides of proximal (shoulder, coxofemoral) and distal (hand, knee) joints, as well as constitutional manifestations -fever, reduced appetite, weakness and/or loss of weight [8,14]. One should stress that in reality the PMR diagnosis is made whenever there is a combination of typical clinical manifestations with an accelerated erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) rate; the diagnostic precision growing when there is subdeltoid bursitis, tenosynovitis of biceps brachii and/or synovitis of shoulder joint [7]; the circle of differential diagnostic includes a late-onset RA, GCA, chondrocalcinosis, infections and malignant tumors [8,15].…”

“…One of the key PMR clinical associations requiring an urgent rheumatologist's attention and escalated glucocorticoid (GC) dose is the giant cell arteritis (GCA) and the attending risk of irreversible blindness and aortal complications developing. The issue of PMR's association with malignant tumors is moot, whether in terms of it being the risk factor (RF) of their development or in terms of a paraneoplastic syndrome [7][8][9][10][11][12][13][14][15][16].…”