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Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician)

https://doi.org/10.21518/2079-701X-2021-4-164-169

Abstract

In recent decades, there has been an increase in the number of elderly people. Among the patients of the primary care physician, without a doubt, those who are over 60 years old predominate. A feature of the elderly is polymorbidity. Combined pathology, numerous complaints of patients make it difficult to diagnose diseases, require patience from the doctor, and, of course, knowledge. There are diseases that are peculiar only to the elderly, developing only after 50 years. These include rheumatic polymyalgia. This pathology is not frequent and, in this regard, is not very familiar to outpatient therapists. However, it is to them that elderly patients turn with complaints of pain and stiffness in the shoulder and/or pelvic girdle, in the neck, in the joints of the hands, fever, weight loss, sleep disorders, depression, general malaise (the main complaints of patients with rheumatic polymyalgia). The above-mentioned clinical manifestations, as well as the high laboratory activity inherent in this disease, make the doctor look for malignant neoplasms, infectious, systemic processes. This takes a long time, the diagnosis is delayed, the sufferings of the patient are prolonged. The article presents data on the prevalence, clinical features, methods of diagnosis of rheumatic polymyalgia and its differential diagnosis. The criteria of the disease, the principles of management of the patient at the outpatient stage  (step-by-step treatment with glucocorticoids, alternative approaches, prevention of side effects of therapy, which develop quite often) are also given. Awareness of primary care physicians about rheumatic polymyalgia, its manifestations and diagnostic methods will speed up the diagnosis, timely consultation of the patient with a rheumatologist, which will allow you to start adequate treatment, significantly improve the quality of life of an elderly patient, and prevent the destabilization of concomitant diseases.

About the Author

M. S. Svetlova
Petrozavodsk State University
Russian Federation

Marina S. Svetlova, Dr. Sci. (Med.), Associate Professor, Professor of the Department of Hospital Therapy

33, Lenin Ave., Petrozavodsk, 185910



References

1. Satybaldyev A.M., Demidova N.V., Savushkina N.M., Gordeev A.V. Polymyalgia rheumatica. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2018;56(2):215–227. (In Russ.) doi: 10.14412/1995-4484-2018-215-227.

2. Satybaldyev A.M. The evolution of diagnosis of polymyalgia rheumatica. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2019;57(6):693–698. (In Russ.) doi: 10.14412/1995-4484-2019-693-698.

3. Hunder G.G. The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970. Mayo Clin Proc. 2006;81(8):1071–1083. doi: 10.4065/81.8.1071.

4. Gonzalez-Gay M.A., Vazquez-Rodriguez T.R., Lopez-Diaz M.J., Miranda-Filloy J.A., Gonzalez-Juanatey C., Martin J., Llorca J. Epidemiology of giant cell arteritis and polymyalgia rheumatic. Arthritis Rheum. 2009;61(10):1454–1461. doi: 10.1002/art.24459.

5. Nesher G., Breuer G.S. Giant cell arteritis and polymyalgia rheumatica: 2016 update. Rambam Maimonides Med J. 2016;7(4):e0035. doi: 10.5041/RMMJ.10262.

6. Gonzalez-Gay M.A. Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum. 2004;33(5):289–293. doi: 10.1016/j.semarthrit.2003.09.007.

7. Salvarani C., Pipitone N., Versari A., Hunder G.G. Clinical features of polymyalgia rheumatic and giant cell arteritis. Nat Rev Rheumatol. 2012;8:509–521. doi: 10.1038/nrrheum.2012.97.

8. Camellino D., Cimmino M.A. Imaging of polymyalgia rheumatica:indications on its pathogenesis, diagnosis and prognosis. Rheumatology (Oxford). 2012;51(1):77–86. doi: 10.1093/rheumatology/keq450.

9. Salvarani C., Barozzi L., Cantini F., Niccoli L., Boiardi L., Valentino M. et al. Cervical interspinous bursitis in active polymyalgia rheumatica. Ann Rheum Dis. 2008;67(6):758–761. doi: 10.1136/ard.2007.084723.

10. Salvarani C., Barozzi L., Boiardi L., Pipitone N., Bajocchi G.L., Macchioni P.L. et al. Lumbar interspinous bursitis in active polymyalgia rheumatic. Clin Exp Rheumatol. 2013;31(4):526–531. Available at: https://pubmed.ncbi.nlm.nih.gov/23739147.

11. Chou C.T., Schumacher H.R. Jr. Clinical and pathologic studies of synovitis polymyalgia rheumatic. Arthritis Rheum. 1984;27(10):1107–1117. doi: 10.1002/art.1780271005.

12. Cantini F., Salvarani C., Olivieri I., Barozzi L., Macchioni L., Niccoli L. et al. Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome:a prospective follow up and magnetic resonance imagine study. Ann Rheum Dis. 1999;58(4):230–236. doi: 10.1136/ard.58.4.230.

13. Salvarani C., Cantini F., Oliviery I., Hunder G.S. Polymyalgia rheumatic: A disorder of extraarticular synovial structures? Rheumatology. 1999;26(3):517–521. Режим доступа: https://pubmed.ncbi.nlm.nih.gov/10090155.

14. Kermani T.A., Warrington K.J. Polymyalgia rheumatic. Lancet. 2013;381(9860):63–72. doi: 10.1016/S0140-6736(12)60680-1.

15. González-Gay M.A., García-Porrúa C., Vázquez-Caruncho M., Dababneh A., Hajeer A., Ollier W.E. The spectrum of polymyalgia rheumatic in northwestern Spain: incidence and analysis of variable associated with relapse in a 10 year study. J Rheumatol. 1999;26(6):1326–1332. Available at: https://pubmed.ncbi.nlm.nih.gov/10381051.

16. Salvarani C., Cantini F., Macchioni P., Olivieri I., Niccoli L., Padula A., Boiardi L. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective follow-up study. Arthritis Rheum. 1998;41(7):1221–1226. doi: 10.1002/1529-0131(199807)41:73.0.CO;2-W.

17. Pipitone N., Salvarani C. Update on polymyalgia rheumatic. Eur J Intern Med. 2013;24(7):583–589. doi: 10.1016/j.ejim.2013.03.003.

18. Salvarani C., Cantini F., Hunder G.G. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372(9634):234–245. doi: 10.1016/S0140-6736(08)61077-6.

19. Yates M., Graham K., Watts R.A., MacGregor A.J. The prevalence of giant cell arteritis and polymyalgia rheumatic in UK primary care population. BMC Musculoscelet Disord. 2016;17:285. doi: 10.1186/s12891-016-1127-3.

20. Pease C.T., Haugeberg G., Montague B., Hensor E.M., Bhakta B.B., Thomson W. et al. Polymyalgia rheumatic can be distinquished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study. Rheumatology. 2009;48(2):123–127. doi: 10.1093/rheumatology/ken343.

21. Gonzales-Gay M.A., Garcia-Porrua C., Salvarani C., Hunder G.G. Diagnostic approach in a patient presenting with polymyalgia. Clin Exp Rheumatol. 1999;17(3):276–278. Available at: https://pubmed.ncbi.nlm.nih.gov/10410257.

22. Bird H.A., Leeb B.F., Montecucco C.M., Misiuniene N., Nesher G., Pai S. et al. A comparison of the sensitivity of diagnostic criteria for polymyalgia rheumatic. Ann Rheum Dis. 2005;64(4):626–629. doi: 10.1136/ard.2004.025296.

23. Dasgupta B., Cimmino M.A., Maradit-Kremers H., Schmidt W.A., Schirmer M., Salvarani C. 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(4): 484–492. doi: 10.1136/annrheumdis-2011-200329.

24. Gonzales-Gay M.A., Garcia-Porrua C., Salvarani C., Hunder G.G. Diagnostic approach in a patient presenting with polymyalgia. Clin Exp Rheumatol. 1999;17(3):276–278. Available at: https://pubmed.ncbi.nlm.nih.gov/10410257.

25. Chuang T.Y., Hunder G.G., Ilstrup D.M., Kurland L.T. Polymyalgia rheumatic: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97(5):672–680. doi: 10.7326/0003-4819-97-5-672.

26. Korkmaz C., Yıldız P. Giant cell arteritis, polymyalgia rheumatica, and lateonset rheumatoid arthritis: Can they be components of a single disease process in elderly patients? Eur J Rheumatol. 2017;4(2):157–160. doi: 10.5152/eurjrheum.2016.039.

27. Dasgupta Bh., Dejaco Chr. (еds.). Differential diagnosis. In: Polymyalgia rheumatic and Giant cell Arteritis. Oxford: Oxford University Press; 2016. Available at: https://oxfordmedicine.com/view/10.1093/med/9780198729204.001.0001/med-9780198729204.

28. Dejaco C., Singh Y.P., Perel P. et al. Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systemic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica. Ann Rheum Dis. 2015;74(10):1808–1817. doi: 10.1136/annrheumdis-2015-207578.

29. Satybaldyev A.M. Rheumatic polymyalgia. In: Nasonov E.L. (ed.). Rheumatology. Russian clinical guidelines. Moscow: GEOTAR-Media; 2017, рp. 205–209. (In Russ.)

30. Yates M., Watts R.A., Swords F., MacGregor A.J. Glucocorticoid withdrawal in polymyalgia rheumatica: the theory versus the practice. Clin Exp Rheumatol. 2017;35(1):1–2. Available at: https://pubmed.ncbi.nlm.nih.gov/28079505.

31. Dejaco C., Singh Y.P., Perel P., Hutchings A., Camellino D., Mackie S. et al. 2015 recommendations for management of Polymyalgia Rheumatica European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2015;67(10):2569– 2580. doi: 10.1002/art.39333.

32. Maradit Kremers H., Reinalda M.S., Crowson C.S., Davis J.M. 3rd, Hunder G.G., Gabriel S.E. Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Rheum. 2007;57(2):279–286. doi: 10.1002/art.22548.

33. Gabriel S.E., Sunku J., Salvarani C., O’Fallon W.M., Hunder G.G. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum. 1997;40(10):1873–1878. doi: 10.1002/art.1780401022.

34. Myklebust G., Wilsgaard T., Jacobsen B.K., Gran J.T. Causes of death in polymyalgia rheumatica. A prospective longitudinal study of 315 cases and matched population controls. Scand J Rheumatol. 2003;32(1):38–41. doi: 10.1080/03009740310000382.

35. Kang J.H., Sheu J.J., Lin H.C. Polymyalgia rheumatica and the risk of stroke: a three-year follow-up study. Cerebrovasc Dis. 2011;32(5):497–503. doi: 10.1159/000332031.

36. Rizolli R., Adachi J.D., Cooper C., Dere W., Devogelaer J.P., Diez-Perez A. et al. Management of glucocorticoidinduced osteoporosis. Calcif Tissue Int. 2012;91(4):225–243. doi: 10.1007/s00223-012-9630-5.

37. Gran J.T., Myklebust G., Wilsgaard T., Jacobsen B.K. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology. 2001;40(11):1238–1242. doi: 10.1093/rheumatology/40.11.1238.

38. Rizolli R., Biver B. Glucocorticoid-induced osteoporosis: who to treat with what agent? Nat Rev Rheumatol. 2015;11:98–109. doi: 10.1038/nrrheum.2014.188.

39. Mok C.C., Ho L.Y., Ma K.M. Switching of oral bisphosphonates to denosumab in chronic glucocorticoid users: a 12-month randomized controlled trial. Bone. 2015;75:222–228. doi: 10.1016/j.bone.2015.03.002.

40. Caporali R., Cimmino M.A., Ferraccioli G., Gerli R., Klersy C., Salvarani C., Montecucco C. Prednisolone plus methotrexate for polymyalgia rheumatica: a randomized, doubleblind, placebo-controlled trial. Ann Intern Med. 2004;141(7):493–500. doi: 10.7326/0003-4819-141-7-200410050-0000.5.

41. van der Veen M.J., Dinant H.J., van Booma-Frankfort C., van Albada-Kuipers G.A., Bijlsma J.W. Can methotrexate be used as a steroid sparing agent in the treatment of polymyalgia rheumatica and giant cell arteritis? Ann Rheum Dis. 1996;55(4):218–223. doi: 10.1136/ard.55.4.218.


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For citations:


Svetlova MS. Rheumatic polymyalgia: clinic, diagnosis, principles of therapy (to help the primary care physician). Meditsinskiy sovet = Medical Council. 2021;(4):164-169. (In Russ.) https://doi.org/10.21518/2079-701X-2021-4-164-169

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