Ревматическая Полимиалгия: Объединяя Усилия Европейских Ревматологических Обществ

Puzanova, O.G.; Moshkovska, Yu.О.; Соболь, В О

doi:10.22141/2224-1507.10.3.2020.212033

Cited by 2 publications

(7 citation statements)

References 33 publications

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“…The indications for the PMR patient's referral to a rheumatologist are reflected in the recommendation № 4 from the Italian guidelines; they are generally consistent with principle C from the German-speaking countries [28][29] and include age under 60 years and other atypical PMR manifestations (peripheral arthritis, systemic manifestations, and a low level of inflammatory markers) as well as the detected risk factors in the medical history or patient status: risk factors of GC AE (diabetes, osteoporosis, glaucoma etc. ), risk factor refractoriness to GC, risk factors of relapse development (female gender, erythrocyte sedimentation rate (ESR) > 40 mm/hour, peripheral arthritis) and risk factors of a protracted treatment.…”

Section: Notes: Accp -Anti-cyclic Citrullinated Protein Antibodies; Ae -Adverse Effect; Ah -Arterial Hypertension; Ap -Alkaline Phosphatamentioning

confidence: 66%

“…Published at the similar time, the DGRh/ ÖGR/SGR guidelines [28] by the German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie (DGRh)), Austrian Society of Rheumatology and Rehabilitation (Österreichische Gesellschaft für Rheumatologie (ÖGR)) and Swiss Society of Rheumatology (Schweizerische Gesellschaft für Rheumatologie (SGR)) were intended to overcome the existing divergences in the PMR management tactics in those countries, based on the adapted 2015 EULAR/ACR recommendations, original sources and 2.6 thousand new evidence being obtained in 2014-2016 and reviewed accordingly. The information analysis showed that over 2/3 of the DGRh/ÖGR/SGR guidelines were based on the expert opinion and supported the importance of strengthened evidence base for the various aspects of PMR management [29].…”

Section: Introductionmentioning

confidence: 81%

“…What allows us to rule out the PMR's paraneoplastic nature and make an early Methotrexate prescription to the patient risk groups? This issue was considered by the 2018 DGRh/ÖGR/SGR guidelines [28] and by us [29]: among the possible risk factors of PMR's association with an oncological disease there are: age over 75 years, male gender, present peripheral arthritis and especially polyarthritis affecting 6 or more joints, as well as the muscle and joint syndrome asymmetry, accentuated systemic manifestations in subjects under 50 years, ESR < 40 or > 100 mm/ hour.…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

“…cochrane.org)). Nevertheless, based on the consensus approach, all the elderly patients receiving a protracted GC treatment are recommended to take regular exercises by EULAR/ACR (2015), DGRh/ÖGR/SGR (2018), SIR (2020) and other medical societies, in order to maintain the muscle mass and function, to reduce the fracture risk [24,[28][29][30].…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

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Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Puzanova¹

2021

PJS

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At the beginning of the Healthy Ageing Decade, a number of guidelines were published describing management of the rheumatic diseases of the elderly. The aim of the paper is to characterize and discuss the Italian Society of Rheumatology’s guideline for polymyalgia rheumatica (2020) and the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology’s (2018) recommendation for positron-emission tomography/computed tomography imaging to diagnose the large vessel vasculitis and polymyalgia rheumatica. The following methods were used: original texts of recommedations, their content and methodology behind the development of both guidelines were studied by means of information analysis and compared with the recommendations for the management of polymyalgia rheumatica and giant cell arteritis elaborated in 2018–2020 by the European League Against Rheumatism, American College of Rheumatology; the German, Austrian, Swiss and British rheumatological societies; the European Headache Federation and their references. We’ve established the priority of consensus approach for the development of modern guidelines for polymyalgia rheumatica. The specific feature of the Italian guideline’s development is the search for prototypes restricted to the two evidence-based medicine databases and the grey literature as well as selection of three international guidelines for adaptation, one of them elaborated by the societies for nuclear medicine. The following issues were updated: the patient management in primary care (whose algorithm is proposed), including the conserted clinical decision-making and alertness to the giant cell arteritis. Out of the first-line therapy tools, only the initial doses of glucocorticoids are evidence-based, and their reduction is allowed as an alternating regimen. The ineffectiveness of hydroxichloroquine use is justified, while both azathioprine and alternative medical drugs are not subject to discussion. It is necessary to identify the risk factors for vasculitis and its relapses, longterm glucocorticoid use and their side effects. For the first time, the use of positron-emission tomography/computed tomography is recommended for detecting of vasculitis. The recommendation for adjuvant therapy with methotrexate and abstaining from the biologic agents is found the most evidence-based, strongest and consistent; referral to a rheumatologist being the least agreed-on position. Conclusion. Solving such an urgent healthcare problem as improving the quality of polymyalgia rheumatic management suggests the medical standards being raised on the most clinically important issues, the importance of at-risk patient identification and referral to rheumatologists and ophthalmologists, and consideration of the methotrexate’s benefits.

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Section: Notes: Accp -Anti-cyclic Citrullinated Protein Antibodies; Ae -Adverse Effect; Ah -Arterial Hypertension; Ap -Alkaline Phosphatamentioning

confidence: 66%

Section: Introductionmentioning

confidence: 81%

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

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Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Puzanova¹

2021

PJS

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“…Discussing the peripheral arthritis as an "atypical" sign requiring rheumatologist's consultations and being a risk factor of PMR's paraneoplastic character whenever ≥6 joints are involved [41], we should point out that the engagement of knee, radiocarpal and sternoclavicular joints [1,38] turned out to be almost inherent for the disease: the frequency of gonitis being detected by PET was 50 % [55]. As to the periarticular FDG uptake, the PMR is most commonly characterized by the shoulder girth localization (Malik D. et al, 2020) [56].…”

Section: лекції огляди / Lectures Reviewsmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Puzanova¹,

Лызиков²

2021

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The issue of improved diagnosis of both rheumatic diseases of the elderly and aortic diseases does not lose its relevance. In terms of aortic aneurysms, dissection and ruptures and their attended pathogenesis, both inflammation and structural wall damages may be detected with imaging methods whose role is vital. A number of international guidelines deal with the management of polymyalgia rheumatica, giant cell arteritis, or aortic aneurysms. Aortitis is associated with up to 40 % of polymyalgia rheumatica’s cases. The clinical suspicion of aortitis is based on the detection of blood pressure and pulse asymmetry, aortic regurgitation murmur, vascular bruits, as well as persistent polymyalgia rheumatica or inflammatory dorsalgia, pelvis or leg pain. In 2020, the positron emission tomography/computed tomography’s use is approved by the Italian Society for Rheumatology for the diagnosis of vasculitis attended by polymyalgia rheumatica at the secondary healthcare level and by the European Headache Federation for the diagnosis of large vessel giant cell arteritis in the neurological practice. A review of the guideline by the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology (2018) was performed in terms of positron emission tomography with fluorodesoxyglucose combined with computed tomography (angiography) imaging in large vessel vasculitis and polymyalgia rheumatica. It is further compared with the clinical guidelines, other guidelines by the societies of nuclear medicine and new scientific data. Both procedure and patient’s preparation for examination are decribed. The criteria for assessing vasculitis proposed for either clinical practice or clinical studies are considered, as well as the factors influencing the test results and their interpretation (such as atherosclerosis, diabetes, age, body mass index, glucemia’s and acute phase markers’ levels). The guideline substantiates the benefit of both positron emission tomography’s use and its combination with computed tomography to detect extracranial vasculitis, as well as the value of performing computed tomography-angiography at different stages of the disease. There is a need to strengthen evidence on both standard time of fluorodesoxyglucose exposure and the benefit of combining positron emission tomography with computed tomography-angiography, in particular for detection of vasculitis relapses. Finding a consensus for early test’s performing is needed, as well as its score standardization, ensuring reimbursement and implementation of new imaging techniques for the cranial vessels. In the future, the evidence-based approach to managing vasculitis will be supplemented by teranostics.

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Ревматическая Полимиалгия: Объединяя Усилия Европейских Ревматологических Обществ

Cited by 2 publications

References 33 publications

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Годов. Часть I. Группы Риска, Адъювантная Терапия

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

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