Clinical Case Database / Category: Teaching and Training

Polymyalgia rheumatica (PMR)

Publication details

Dr Hasan Tahir, Dr Charles Raine, Dr Judith Bubbear
Foundation Years Journal, volume 9, issue 10, p.48 (123Doc Education, London, November 2015)

Abstract

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatological condition and will be frequently encountered during the Foundation course both as a comorbidity in inpatients and as a new presentation to General Practice. It is one of the most common indications for long-term steroid therapy. It is often initially diagnosed in primary care but a significant proportion are referred to secondary care for assistance with diagnosis and management. There is a broad differential diagnosis for patients presenting with proximal pain and stiffness, and many other conditions may mimic PMR. There is an important overlap with giant cell arteritis (GCA). This review discusses aspects of PMR relevant to the Foundation doctor, including the approach to diagnosis and treatment, and highlights which patients should be referred for specialist opinion.

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Authors

Dr Hasan Tahir (Corresponding author)

Consultant Rheumatologist
Whipps Cross University Hospital
Whipps Cross Road, London E11 1NR
Hasan.Tahir@Bartshealth.nhs.uk

Dr Charles Raine

Rheumatology Registrar
Whipps Cross University Hospital
Whipps Cross Road, London E11 1NR
Charles.Raine@bartshealth.nhs.uk

Dr Judith Bubbear

Consultant Rheumatologist
Whipps Cross University Hospital
Whipps Cross Road, London E11 1NR
Judith.Bubbear@Bartshealth.nhs.uk

References

1. Lawrence RC, Felson DT, Helmick CG, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States Part 2. Arthritis Rheum 2008, 58(1):26-35.
2. Kremers HM, Reinalda MS, Crowson CS, et al. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol 2005; 32: 65–73.
3. Cantini F, Niccoli L, Storri L, et al. Are polymyalgia rheumatica and giant cell arteritis the same disease? Semin Arthritis Rheum 2004, 33:294–301.
4. Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 2009, 61: 1454–61.
5. Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom 1990-2001. Ann Rheum Dis 2006, 65:1093–1098.
6. Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Direct medical costs of polymyalgia rheumatica. Arthritis Rheum. 2005, 15;53(4):578-84.
7. Little MA, Nazar L, Farrington K. Polymyalgia rheumatica preceding small-vessel vasculitis: changed spots or misdiagnosis? QJM. 2004, 97(5):289.
8. Dasgupta B. Concise guidance: diagnosis and management of polymyalgia rheumatica. Clin Med. 2010, 10(3):270-4.
9. Salvarani C, Cantini F, Macchioni P, et al. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 1998, 41(7):1221-6.
10. Helfgott SM, Kieval RI. Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate. Arthritis Rheum. 1996, 39(2):304-7.
11. Cantini F, Salvarani C, Olivieri I, et al. Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study. J Rheumatol. 2001, 28(5):1049.
12. Cantini F, Niccoli L, Nannini C et al. Inflammatory changes of hip synovialstructures in polymyalgia rheumatica. Clin.Exp. Rheumatol 2005, 23(4), 462–468.
13. Schmidt WA, Kraft HE, Vorpahl K, Volker L, Gromnica-Ihle EJ. Color duplex ultrasonography in the diagnosis of temporal arteritis. N Engl J Med. 1997, 337:1336–1342.
14. McGonagle D, Pease C, Marzo-Ortega H, O'Connor P, Gibbon W, Emery P. Comparison of extracapsular changes by magnetic resonance imaging in patients with rheumatoid arthritis and polymyalgia rheumatica. J Rheumatol 2001, 28: 1837–41.
15. Dasgupta B, Cimmino MA, Maradit-Kremers, H et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative Ann Rheum Dis 2012;71:484–492.
16. Macchioni P, Boiardi L, Catanoso M et al. Performance of the new EULAR/ACR classification criteria for polymyalgia rheumatic: comparison with the previous criteria in a single-centre study. Ann Rheum Dis 2014; 73: 1190-93.
17. Dasgupta B, Borg FA, Hassan N, et al. BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology (Oxford). 2010, 49(1):186-90.
18. Mackie SL, Hensor EM, Haugeberg G, Bhakta B, Pease CT. Can the prognosis of polymyalgia rheumatica be predicted at disease onset? Results from a 5-year prospective study. Rheumatology (Oxford) 2010, 49:716-22.
19. Hutchings A, Hollywood J, Lamping DL, et al. Clinical outcomes,quality of life, and diagnostic uncertainty in the fi rst year of polymyalgia rheumatica. Arthritis Rheum 2007, 57: 803–09.
20. Grossman JM, Gordon R, Ranganath VK, et al. American College of Rheumatology 2010 recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 2010, 62(11):1515-26
21. http://www.shef.ac.uk/NOGG/index.html
22. Dejaco C, Duftner C, Cimmino MA et al. Definition of remission and relapse in polymyalgia rheumatica: Data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis 2011, 70:447–453.
23. Caporali R, Cimmino MA, Ferraccioli G et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann.Intern. Med 2004, 141:493–500.
24. Diamantopoulos A, Hetland H, Myklebust G. Leflunomide as a Corticosteroid-Sparing Agent in Giant Cell Arteritis and Polymyalgia Rheumatica: A Case Series. Biomed Res Int. 2013; 120638.

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