Polymyalgia rheumatica natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
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Overview
Polymyalgia rheumatica (PMR) affects the quality of life of the patients. The pain and stiffness in the proximal joints might lead to sleep disturbance as well as inability to do regular daily activities such as getting dressed and getting out of a chair. The symptoms begin rapidly and last for weeks. Once the steroid treatment is initiated, the symptoms resolve rapidly within few days. In fact, the rapid resolution of symptoms with the steroid therapy reinforces the diagnosis of PMR. The steroid treatment can be associated with complications such as weight gain and bone fracture.[1] Approximately 40 to 50% of subjects experience relapse of the symptoms. PMR is associated with giant cell arteritis.
Natural History
- If left untreated, PMR affects the quality of life of the patients. The pain and stiffness in the proximal joints might lead to sleep disturbance as well as inability to do regular daily activities such as getting dressed and getting out of a chair. The symptoms begin rapidly and last for weeks.
Complications
- PMR is associated with giant cell arteritis. While 40 to 60% of patients with giant cell arteritis have PMR, 16 to 21% of patients with PMR develop giant cell arteritis.[2][3][4] Some symptoms of temporal arteritis include severe headaches, scalp tenderness, jaw claudication, fever, distorted vision or aching in the limbs caused by decreased blood flow, and fatigue. Giant cell arteritis is a serious condition that might lead to blindness among other complications and it must be treated with high dose corticosteroids.
- The mainstay of the treatment of PMR is low dose corticosteroids, which is byitself associated with complications. Complications of the steroid treatment include weight gain and bone fracture.[1]
- Myocardial inflammation has been reported in a patient with PMR. The ESR and CRP were elevated but the concentrations of creatine kinase-MB and troponins were normal. Left ventricular dyskinesia and reduced systolic function were evident on echocardiography.[5]
Prognosis
- Once the steroid treatment of PMR is initiated, the symptoms resolve rapidly within few days. In fact, the rapid resolution of symptoms with the steroid therapy reinforces the diagnosis of PMR. Approximately 40 to 50% of subjects experience relapse of the symptoms, which requires longer duration of glucocorticoid treatment.[1] Factors that are associated with relapse are:
- Female sex
- Initial high dose glucocorticoid therapy
- Fast tapering of the glucocorticoid therapy[1]
References
- ↑ 1.0 1.1 1.2 1.3 Kermani TA, Warrington KJ (2013). "Polymyalgia rheumatica". Lancet. 381 (9860): 63–72. doi:10.1016/S0140-6736(12)60680-1. PMID 23051717.
- ↑ Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG (1995). "The incidence of giant cell arteritis in Olmsted County, Minnesota: apparent fluctuations in a cyclic pattern". Ann Intern Med. 123 (3): 192–4. PMID 7598301.
- ↑ Salvarani C, Gabriel SE, O'Fallon WM, Hunder GG (1995). "Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991". Arthritis Rheum. 38 (3): 369–73. PMID 7880191.
- ↑ Franzén P, Sutinen S, von Knorring J (1992). "Giant cell arteritis and polymyalgia rheumatica in a region of Finland: an epidemiologic, clinical and pathologic study, 1984-1988". J Rheumatol. 19 (2): 273–6. PMID 1629827.
- ↑ Mavrogeni S, Bratis K, Mavragani CP (2013). "Myocardial inflammation in polymyalgia rheumatica assessed using cardiac magnetic resonance imaging". Exp Clin Cardiol. 18 (2): 151–2. PMC 3718596. PMID 23940441.