Polymyalgia rheumatica

Kermani, Tanaz A.; Warrington, Kenneth J.

doi:10.1016/s0140-6736(12)60680-1

Cited by 126 publications

(108 citation statements)

References 81 publications

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“…The differential diagnosis between PMR and rheumatoid arthritis can be difficult because these conditions may have a similar clinical presentation, especially in the elderly (6). Normal ESR and CRP levels virtually rule out PMR or giant cell arteritis (7).…”

Section: Discussionmentioning

confidence: 99%

Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective

Bıtık¹,

Mercan²,

Tufan³

et al. 2015

Eur J Rheumatol

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Objective: In the case of high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, the diagnosis of the underlying disease can be challenging especially in serologically unrevealing patients who have nonspecific clinical findings. We aimed to investigate the final distribution of definitive diagnoses in patients who initially presented with nonspecific clinical findings and sustained elevations in serum ESR/CRP levels. Material and Methods:The medical records of patients hospitalized in a rheumatology clinic between January 2010 and January 2011 were retrospectively analyzed. The patients were classified into two main groups: those with previously diagnosed underlying rheumatic disease (RD) and those without. The groups were analyzed for the final distribution of definitive diagnoses.Results: Out of 112 patients in the general study population, 47 had a previous RD and 65 had no previous history of RD. In these 65 patients, the most common etiology of nonspecific elevations in ESR/CRP levels was new onset RD (52.3%). Polymyalgia rheumatica (PMR) was the most common new onset RD (38% of all new onset RD) followed by seronegative rheumatoid arthritis. The incidences of infections and malignancies were 24.6% and 9.2%, respectively. CRP levels were significantly higher in infections when compared with new onset RD or malignancies (p<0.05). In patients with previous RD, the flare of the underlying disease was the most common etiology of nonspecific elevations in ESR/CRP levels (n=39, 83%, 20 female/19 male). Conclusion:Extraordinarily high levels of serum CRP in a patient with nonspecific clinical findings should raise suspicion for non-rheumatic diagnoses, such as infection and malignancy, even in the presence of a previously diagnosed RD. Advanced radiological investigation is justified in these cases to rule out malignancy.

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Section: Discussionmentioning

confidence: 99%

Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective

Bıtık¹,

Mercan²,

Tufan³

et al. 2015

Eur J Rheumatol

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“…There are currently no formal diagnostic criteria for PMR and recently published classification criteria for PMR do not include fatigue as a core criterion (3)(4)(5) despite it being a common feature reported by many patients (1). A key finding from this study is the high frequency of consultation for fatigue symptoms prior to a diagnosis of PMR being made.…”

Section: Discussionmentioning

confidence: 87%

“…Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study DJ Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of older (>50 years) adults and is characterized by pain and stiffness in the shoulder and hip girdles and elevated inflammatory markers (1). Studies suggest that the majority of patients with PMR are diagnosed and managed exclusively in primary care (2,3).…”

mentioning

confidence: 99%

Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study

Green

Müller

Mallen

et al. 2014

Scandinavian Journal of Rheumatology

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Objectives: Polymyalgia rheumatica (PMR) is the commonest inflammatory disorder of older adults. Although not part of the recently published classification criteria, patients with PMR frequently complain of fatigue. We compared consultation for fatigue and sleep problems between individuals with and without PMR. Method: Consulters receiving a Read-coded diagnosis of PMR at nine general practices between 2000 and 2009 were matched by age, gender, general practice, and year of consultation to four patients without PMR. Fatigue and sleep problems were defined using Read codes. Cox regression was used to determine the association between PMR diagnosis and consultation for a fatigue/sleep problem. Results: In total, 549 PMR patients were identified. Their mean (SD) age was 73.9 (8.6) years and 71% of the participants were female. Prior to the index date, 33 PMR patients and 80 matched non-PMR patients consulted with fatigue (0.43 vs. 0.25 consultations per 10 000 person-years, p ¼ 0.006). PMR was associated with significantly more multiple fatigue consultations in the 12 months before PMR diagnosis [hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.23-3.08]; no significant difference was seen in rates of consultations for sleep problems between patients with and without PMR. Conclusions: PMR patients were significantly more likely to have had multiple fatigue consultations before being diagnosed with PMR. Given the overproduction of inflammatory cytokines seen in PMR, this fatigue may represent a prodromal phase prior to consulting with more classical musculoskeletal symptoms. This suggests that clinicians should consider PMR as a potential diagnosis in older patients consulting with fatigue.

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“…40–60% of patients with GCA can have PMR on initial presentation while 16–21% of patients with PMR develop GCA during their lifetime. [13]…”

Section: Discussionmentioning

confidence: 99%

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

Fayyaz

2018

Journal of Community Hospital Internal Medicine Perspectives

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Carotid atherosclerosis and giant cell arteritis (GCA) are two distinct medical conditions with an overlapping clinical spectrum of vascular symptoms such as vision loss and ischemic stroke. This is because both diseases cause arterial ischemia with a predilection for carotid vasculature. In addition, high-vascular risk individuals who are diagnosed with GCA are usually elderly with age >55 years with high-vascular risk and thus can have underlying atherosclerosis. All these factors can pose a diagnostic dilemma for the physicians as GCA is a medical emergency which if left untreated can result in significant morbidity and mortality. Thus, it is important to avoid attributing occlusive arterial disease in elderly patients to atherosclerosis alone because some may have GCA. We present a case report in which presence of diffuse atherosclerosis was a major pitfall while making a timely diagnosis of GCA.

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Polymyalgia rheumatica

Cited by 126 publications

References 81 publications

Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective

Differential diagnosis of elevated erythrocyte sedimentation rate and C-reactive protein levels: a rheumatology perspective

Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study

Case report: giant cell arteritis in a patient with carotid atherosclerosis – a diagnostic dilemma

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