Polymyalgia rheumatica: An updated review

Abstract

Polymyalgia rheumatica should be suspected in older patients with bilateral shoulder and hip stiffness that is worse in the morning and improves with use. An array of nonspecifi c musculoskeletal complaints, constitutional symptoms, and elevated serum infl ammatory markers may be present, so other conditions should also be considered. Prolonged glucocorticoids with patient-tailored dosing and duration are the mainstay of treatment. Corticosteroid-sparing therapy with adjunctive methotrexate may benefi t select patients. KEY POINTSRheumatoid arthritis, late-onset spondyloarthritis, and RS3PE (remitting seronegative symmetrical synovitis with pitting edema) are important mimics of polymyalgia rheumatica.Diagnosis usually requires either an elevated erythrocyte sedimentation rate (> 30 or 40 mm/h) or C-reactive protein level (> 6 mg/dL).Ultrasonographic evidence of infl ammation, especially subacromial bursitis, increases diagnostic specifi city.Patients should be evaluated at diagnosis and periodically for the development of giant cell arteritis.To help avoid relapse, therapy should continue until symptoms resolve, followed by slow tapering.Preliminary studies show possible benefi t from tocilizumab, an interleukin-6 receptor antibody, as monotherapy or for refractory cases.

Chronic Candida albicans meningitis misdiagnosed as polymyalgia rheumatica and successfully treated with voriconazole

“…albicans meningitis. The misdiagnosis of polymyalgia rheumatica was a consequence of the symptoms muscle pain in the proximal upper extremities, temporal region pain with tenderness on palpation, fatigue, elevated body temperature up to 38.3°C, and weight loss considered typical for this disease 26 …”

Is Tocilizumab Effective and Safe in Polymyalgia Rheumatica and Giant-Cell Arteritis With Polymyalgia Rheumatica?

“…Polymyalgia rheumatica (PMR) is a systemic inflammatory condition. The annual incidence ranges from 12 to 60 cases per 100,000 across different populations and increases with age [1]. Moreover, 15-20% of patients with PMR develop giant-cell arteritis (GCA), a large-vessel vasculitis with significant morbidity [2].…”

“…However, the neck, upper arms, and thighs are also affected. Low-dose glucocorticoid (GC) therapy is the standard treatment according to the European League Against Rheumatism recommendations and the American College of Rheumatology, mainly because it is effective [1][2][3][4]. Nevertheless, long-term treatment is usually needed (>12 months) [1].…”

“…Low-dose glucocorticoid (GC) therapy is the standard treatment according to the European League Against Rheumatism recommendations and the American College of Rheumatology, mainly because it is effective [1][2][3][4]. Nevertheless, long-term treatment is usually needed (>12 months) [1]. Moreover, relapses occurred in 33% of patients while on GC tapering, increasing the time of its use and predisposing patients to developing adverse side effects, such as osteoporosis, diabetes, cataract, glaucoma, infections, and cardio-cerebral vascular events [4,5].…”

Is the absence of prolonged morning stiffness at the time of diagnosis of polymyalgia rheumatica a paraneoplastic warning?

“…Polymyalgia rheumatica is a common inflammatory rheumatic disease in the elderly. Although no diagnosis test is available, the diagnosis is based on clinical and laboratory findings, with morning stiffness (MS) lasting > 45 minutes being one of the most significant features [2,3].…”