Polymyalgia rheumatica


Polymyalgia rheumatica

Description, Causes and Risk Factors:

A syndrome within the group of collagen diseases different from spondylarthritis or from humeral scapular periarthritis by the presence of an elevated sedimentation rate; much commoner in women than in men.

Polymyalgia rheumatica (PMR) is relatively common disease throughout World. It is estimated that one in every 1,200 people develop the condition every year. Polymyalgia rheumatica is an age-related condition. Most people diagnosed with the condition are over 70 years old and cases affecting people younger than 50 are almost unheard of.

The condition is more common in women than men. It is more widespread among white people, particularly those of Americans, Asians, and European descents. The cause of polymyalgia rheumatica is unclear. However, it is thought that a combination of genetic and environmental factors is responsible.

An autoimmune process may play a role in PMR development. PMR is associated with the HLA-DR4 haplotype. High levels of IL-6 are associated with increased disease activity. Many investigators believe that non-erosive synovitis and tenosynovitis are responsible for many symptoms of PMR.

Risk Factors:

    Advancing age - the condition is more common in people aged 50 years and over, with most sufferers diagnosed at around 70 years.

  • Gender - women are more likely to develop the condition than men.

  • Race - Caucasian (white) people are most susceptible.

  • Habits - Smokers, tobacco & alcohol abusers are also at high risk for PMR.

About 3 in 10 people with PMR also develop a related condition called giant cell arteritis (GCA). This may be at the same time or some time earlier or later than when PMR develops. GCA can be much more serious than PMR. GCA causes inflammation of arteries (blood vessels). The arteries most commonly affected are those which pass over the temples (the sides of the forehead next to the eyes). The eye can be affected in some cases. This can lead to serious eye problems, even blindness. Rarely, other arteries such as those going to the brain are affected.

Immunogenetic studies support a polygenic basis for GCA and PMR. Although most studies confirm an association between HLA-DRB1*04 alleles and GCA, the strength of this association with PMR varies between different populations. Interleukin-1 (IL-1) and tumor necrosis factor alpha (TNF-?) gene polymorphisms have weak association with GCA and PMR. In Spain, an IL-6 polymorphism was associated with the expression of PMR symptoms in GCA patients. Additionally, in this Spanish population, the RANTES polymorphism was associated with PMR and not GCA.

Symptoms:

If you have polymyalgia rheumatica (PMR) you'll have severe and painful stiffness in the morning, especially in your shoulders and thighs. PMR often strikes suddenly, appearing over a week or 2 and sometimes just after a flu-like illness.

The symptoms are quite different from the ache you may feel after exercise. The pain and stiffness is often widespread and made worse by movement. It may also wake you at night.

Other symptoms include:

    Feeling unwell.

  • A slight fever.

  • Headaches.

  • Eye problems.

  • Weight loss.

  • Overwhelming tiredness.

  • Feeling low or depressed.

Diagnosis:

No specific test can diagnose PMR. Your doctor will make the diagnosis based on your symptoms, a physical examination and blood tests for inflammation. They could test for:

    Erythrocyte sedimentation rate (ESR).

  • C-reactive protein (CRP).

  • Plasma viscosity (PV).

Having inflammation alone would not confirm the diagnosis because it's a feature of many other conditions. Your doctor will need to do some tests to rule these out, including tests for rheumatoid arthritis (RA). You may also need to have x-rays or ultrasound scans of your shoulders and hips.

Anemia is quite common in PMR so your doctor may test for this.If your doctor suspects you have giant cell arteritis (GCA), then he may order ultrasound, CAT scan, and cerebral angiography.

Treatment:

The main treatment for the condition is a steroid medication (corticosteroids) called prednisolone, which is used to help relieve your symptoms. You will initially be prescribed a high dose of prednisolone, which will be tapered over time.

Most people with PMR will need to take a long-term course of corticosteroid treatment (lasting one to two years) to prevent their symptoms returning.

Methotrexate has been investigated in 3 randomized studies in newly diagnosed PMR. One study used methotrexate at 7.5 mg/week plus 20 mg/day of prednisone and found no benefit in outcomes after 2 years of follow-up. Another study used oral and intramuscular methotrexate at a higher dose of 10 mg/week added to the prednisone regimen versus prednisone regimen alone. Overall, the patients receiving methotrexate 10 mg/week plus prednisone experienced corticosteroid-sparing effects compared with patients receiving prednisone alone.

Antitumor necrosis factor alpha (anti-TNF-?) agents have also been investigated as corticosteroid-sparing agents in PMR. A randomized study with infliximab revealed no benefit. The only randomized trial using azathioprine (150 mg/d) during the maintenance phase of PMR showed a high frequency of adverse drug effects, a high number of patient withdrawal from the study, although a lower cumulative dose of corticosteroid at 52 weeks. At this time, the small number of completers and the high number of giant cell arteritis patients in the study make the study results difficult to interpret.

More studies are needed to better determine if steroid-sparing agents should be recommended in PMR.

Symptomatic palliation of pain with analgesic therapy alone with close monitoring may be preferable in patients with intolerable adverse effects from corticosteroids (e.g., uncontrolled diabetes mellitus, severe symptomatic osteoporosis, psychosis).

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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