Recommendations of diagnosis and treatment of giant cell arteritis and polymyalgia rheumatic in China / 中华内科杂志

Polymyalgia rheumatica (PMR) is a syndrome characterized by pain and morning stiffness in the neck and shoulder and pelvic girdles, as well as raised acute-phase reactants, with or without systemic symptoms, such as fever. Giant cell arteritis (GCA) is a systemic vasculitis of unclear etiology that involves systemic arteries, principally affecting medium- and large-sized arteries with skipped, segmental alterations and granulomatous vasculitis seen on histopathology. In China, epidemiological data describing GCA are still limited; thus, the prevalence might be underestimated. The involvement of vessels in GCA can cause irreversible visual impairment or loss and stroke, which are serious complications. PMR is three times more prevalent than GCA, and other specific diseases should be excluded before the diagnosis is established. PMR symptoms can be present in 40%-60% of patients with GCA. Conversely, GCA can develop in 15% of patients with PMR. Chinese Rheumatology Association, based on the clinical diagnosis and treatment guidelines in 2005, utilizing the experience and guidelines of diagnosis and treatment at home and abroad, formulated this specification to standardize the diagnosis and treatment of GCA and PMR and improve the patient′s prognosis.

Magnetic resonance imaging findings in patients with polymyalgia rheumatica / Achados de ressonância magnética em pacientes com polimialgia reumática

Abstract Objective: To describe the prevalence of magnetic resonance imaging (MRI) findings in patients with the clinical diagnosis of polymyalgia rheumatica (PMR). Materials and Methods: Sixteen consecutive patients with untreated PMR, meeting the American College of Rheumatology criteria, underwent MRI examinations of the shoulder(s), hip(s), or both, depending on clinical complaints. Six patients also underwent MRI of the spine. Results: We evaluated 24 shoulders, among which we identified subacromial-subdeltoid bursitis in 21 (87.5%), glenohumeral joint effusion in 17 (70.8%), and fluid distention of the long head of the biceps tendon sheath in 15 (62.5%). Peritendinitis and capsular edema were observed in 21 (87.5%) and 17 (70.8%) shoulders, respectively. We also evaluated 17 hips, identifying hip joint effusion in 12 (70.6%), trochanteric bursitis in 11 (64.7%), peritendinitis in 17 (100%), and capsular edema in 14 (82.4%). All six of the patients who underwent MRI of the spine were found to have interspinous bursitis. Conclusion: Subacromial-subdeltoid bursitis, glenohumeral joint effusion, and hip joint effusion are common findings in patients with PMR. In addition, such patients appear to be highly susceptible to peritendinitis and capsular edema. There is a need for case-control studies to validate our data and to determine the real impact that these findings have on the diagnosis of PMR by MRI.

Resumo Objetivo: Descrever os achados de ressonância magnética (RM) mais prevalentes em pacientes com diagnóstico clínico de polimialgia reumática (PMR). Materiais e Métodos: Dezesseis pacientes com PMR não tratada, classificados pelos critérios do American College of Rheumatology, foram submetidos a RM do ombro e/ou quadril, segundo suas queixas clínicas. Seis pacientes também foram submetidos a RM da coluna. Resultados: Foram avaliados 24 ombros, identificando-se bursite subacromial-subdeltoide em 21 (87,5%), sinovite glenoumeral em 17 (70,8%) e distensão líquida da bainha do tendão da cabeça longa do bíceps em 15 (62,5%). Peritendinite e edema capsular foram observados em 21 (87,5%) e 17 (70,8%) ombros, respectivamente. Dezessete quadris foram analisados, identificando-se sinovite em 12 (70,6%), bursite trocantérica em 11 (64,7%), peritendinite em 17 (100%) e edema capsular em 14 (82,4%). Os seis pacientes que realizaram RM da coluna apresentavam bursite interespinhosa. Conclusão: Bursite subacromial-subdeltoide, sinovite glenoumeral e do quadril são achados de imagem prevalentes em pacientes com PMR. Além disso, achados como peritendinite e edema capsular tiveram alta prevalência nesses pacientes. Estudos de caso- controle devem ser realizados para validar esses dados e estabelecer o real impacto desses achados no diagnóstico de PMR.

Paraneoplastic Syndrome in Double Cancer (Renal Cell Carcinoma and Colon Cancer) Presenting with Polymyalgia Rheumatic: A Case Report / 日本プライマリ・ケア連合学会誌

A 68-year-old man underwent surgery for renal cell carcinoma half a year ago, and developed low back and hip pain. The pain did not respond to antibiotics. Collagen disease, in particular ankylosing spondylitis, was suspected and steroids were administered, resulting in the improvement of the symptoms. polymyalgia rheumatica (PMR) was diagnosed.As all symptoms improved following resection of the metastatic lymph nodes, he was diagnosed with paraneoplastic syndrome. A biological preparation (pazopanib) was administered for renal cell carcinoma, but colon cancer was diagnosed, followed by extirpation of the colon tumor. Although the patient had recurrent thigh pain, he was able to leave the hospital temporarily with walking aids.This is the first report of PMR as paraneoplastic syndrome after surgery for renal cell carcinoma in a patient with colon cancer.

Clinical experience of professor - in channel palpation treatment for polymyalgia rheumatica / 中国针灸

Professor - has gradually improved the clinical application of channel palpation treatment based on his more than 50 years clinical practice, and has accumulated rich experience in acupuncture treatment of polymyalgia rheumatica. He believes that "wind, cold and dampness" are the external causes of the disease, physical factors, uncomfortable mood and uncontrolled diet are the internal causes. The meridian-collateral theory is utilized in the diagnosis and detection of the disorders of , and meridians, internal and external causes are solved by expelling the wind, warming the channel to eliminate the coldness, transforming the dampness to relieve pain and regulating the activity. Three cases of clinical application on polymyalgia rheumatica were included in this paper.

Utilidad de la ecotomografía doppler en el diagnóstico de la arteritis de células gigantes / Utility of the doppler ultrasound in the diagnostic approach of giant cell arteritis

Resumen: La arteritis de células gigantes es una vasculitis sistémica frecuente, especialmente en mayores de 50 años. Ante la sospecha clínica el diagnóstico debe ser confirmado con histología o estudios de imágenes. La biopsia de arteria temporal se considera el gold standard, sin embargo, tiene sus limitaciones, una de ellas es la alta tasa de falsos negativos. El estudio por ecotomografía Doppler permite la visualización de las arterias temporales y en manos experimentadas puede constituir un procedimiento diagnóstico alternativo a la biopsia en el estudio inicial de esta entidad. Esta técnica es de fácil acceso, bajo costo, sin riesgos y no expone al paciente a radiación ionizante. En este trabajo revisamos la utilidad clínica de la ecotomografía Doppler en el estudio de la arteria temporal y sus hallazgos imagenológicos en la aproximación diagnóstica a la arteritis de células gigantes, siendo las características de compromiso el engrosamiento parietal arterial hipoecogénico, habitualmente concéntrico, no compresible.

Abstract: Giant cell arteritis is a frequent systemic vasculitis, especially in patients older than 50 years old. When clinically suspected, the diagnosis should be made on the basis of histology or imaging methods. Temporal artery biopsy is considered the gold standard for the diagnosis but it has some caveats, especially the existence of false negatives. Doppler ultrasound study is a low cost, accessible tool that allows visualization of temporal arteries and, in experienced hands, can replace the biopsy in the initial evaluation of the disease, without the risks of ionizing radiation. In this article we review the clinical utility of the temporal artery Doppler ultrasound and its findings in the diagnostic approach of giant cell arteritis, being characteristic a non-compressible, hypoechoic, most commonly concentric arterial wall thickening.

Case of Polymyalgia Rheumatica Misdiagnosed as Infectious Spondylitis

A 60-year-old woman visited the authors' clinic with low back pain and arthralgia. Her symptoms had occurred 6 months previously, and she was treated with an epidural injection and a balloon dilatation procedure based on the assumption of spinal stenosis, but both treatments were ineffective. Her low back pain was aggravated, accompanied by fever and chills over a period of 4 months. As a result, she visited another referral hospital and was diagnosed with infective spondylitis associated with the invasive procedure. Her symptoms improved with antibiotics, but they recurred. When she visited our clinic, she still had continuous low back pain and febrile senses. Magnetic resonance imaging of her lumbar spine revealed interspinous bursitis, and 18 F-fluorodeoxyglucose positron emission tomography showed multifocal synovial inflammation. She was diagnosed with polymyalgia rheumatica and treatment was started on prednisolone and celecoxib. Her symptoms improved dramatically and the inflammatory markers normalized.

Characteristics of Korean Patients with Polymyalgia Rheumatica: a Single Locomotive Pain Clinic Cohort Study

BACKGROUND: Polymyalgia rheumatica (PMR) is a common systemic inflammatory disease of the elderly; however, the clinical characteristics and therapeutic response of PMR in Korea have been rarely studied. METHODS: We reviewed the medical records of 54 Korean patients diagnosed with PMR between January 2009 and February 2017 in a locomotive pain clinic of one tertiary referral hospital. We analyzed epidemiologic and clinical characteristics, therapeutic responses, and prognostic factors for remission-failure at one-year after oral prednisolone treatment. RESULTS: In 54 patients with PMR, 32 (59.3%) were female. The average age at diagnosis was 65.0 ± 10.5 years. Duration of symptoms before diagnosis was 8.1 ± 8.6 months. All patients had shoulder pain (54 patients, 100.0%); 49 patients (90.7%) had hip girdle pain, while 19 patients (35.2%) had peripheral joint pain. Four patients (7.4%) were accompanied by the giant cell arteritis (GCA). There was no seasonal preference for symptom development. Only 19 patients were diagnosed with PMR at initial symptom presentation. At one-year follow-up after oral prednisolone treatment, the remission rate was 35.3% (12/34). Multivariate analysis showed that history of relapse (odds ratio, 6.81; 95% confidence interval, 1.035–44.804) was a significant predictor of remission-failure. CONCLUSION: The rate of remission (35.3%) after oral prednisolone treatment was similar to previous reports in western countries; and GCA is not a rare condition in Korean PMR patients. Misdiagnosis of PMR is common, and heightened consideration for PMR is needed in elderly patients who present inflammatory features of bilateral shoulder pain.

Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome: A Case Report

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome is a rare condition that occurs in elderly individuals. It is characterized by sudden onset of bilateral symmetrical distal tenosynovitis that accompanied by obvious swelling of the hand with pitting edema and absence of rheumatoid factor (RF). This disease entity sometimes presented as overlap syndrome with other rheumatic diseases and needed to be differentiated from those. However, if the diagnosis is confirmed, the response to steroid is good. The purpose of this report is to describe the case of RS3PE syndrome presented with bilateral hand dorsum edema in a middle-aged woman.

Study on the effect of Bazhen granules on the treatment of patients with polymyalgia rheumatica and effect on immune level / 中国生化药物杂志

Objective To investigate the effect of Bazhen granules combined with conventional treatment in patients with polymyalgia rheumatica and effect on immune level.MethodsFrom December 2013 to May 2016 in the second hospital of Shandong University 80 cases with polymyalgia rheumatica were randomly divided into the Banzhen granule group and the conventional group, 40 cases in each group.The two groups were given basic treatment with prednisone.The Bazhen granules group were given Bazhen granules at the same time.The two group were given continuous treatment for 3 months.ResultsBefore treatment, the difference of serum ESR and CRP levels between the Bazhen granules group and the normal group was not statistically significant.After treatment, in the Bazhen granule group, serum ESR, CRP levels were lower than those in the conventional group, the difference was statistically significant (P<0.05);serum CD3+, CD4+, CD4+/CD8+, IgG, IgM, IgA levels were higher than those in the conventional group (P<0.05), CD8+ level was lower than that in the conventional group (P<0.05).The effective rate in the Bazhen granule group 85%was higher than that in the conventional group 62.50% (P<0.05).The total effect rate in the Bazhen granule group95% was higher than that in the conventional group 87.50%, but the difference was not statistically significant.ConclusionThe effect is better that Bazhen granules combined with conventional treatment on the treatment of patients with polymyalgia rheumatica, which can improve the patient's immune level.

Polimialgia reumática: Presentación de caso / Polymialgia Rheumatica: a Case Report

La polimialgia reumática es una enfermedad que generalmente afecta a los individuos mayores de 50 años. Desde 1963 se ha modificado su denominación y clasificación; en la actualidad, para su diagnóstico se cuentan con criterios clínicos e imagenológicos. Entre los criterios imagenológicos se considera especialmente el ultrasonido; sin embargo, la resonancia magnética permite descartar diagnósticos diferenciales y considerar en forma oportuna el diagnóstico de la polimialgia reumática. Esto se destaca en el presente artículo que describe el caso de una paciente de 56 años con antecedentes de perioniquia secundaria a pedicura y, como complicación, una espondilodiscitis. Posteriormente aparece dolor articular simétrico, matutino, en caderas y hombros; por medio de resonancia magnética se establece el diagnóstico del proceso infeccioso inicial y se descarta el compromiso infeccioso articular, lo cual se asocia a criterios clínicos y se diagnostica y trata la polimialgia reumática.

Polymyalgia rheumatica is a disease that usually affects people over 50 years old. Since 1963, its name and classification have been modified; at present, there are clinical and imaging data criteria for its diagnosis. Among the imaging criteria, ultrasound plays a pivotal role; however, magnetic resonance helps to rule out different diagnoses, as well as to clarify the diagnosis of polymyalgia rheumatica. This paper highlights this fact by presenting the case of a 56-year old female patient with a history of paronychia secondary to pedicure, and spondylodiscitis as a complication. Later, she reports symmetrical joint pain in hips and shoulders in the morning; magnetic resonance is used to establish the initial infective process, while infective joint involvement is discarded; it is associated with clinical criteria in order to establish the diagnosis and treatment of polymyalgia rheumatic.

Polimialgia reumática / Polymyalgia rheumatica

La polimialgia reumática es una enfermedad inflamatoria crónica común en la poblacióngeriátrica. Su cuadro clínico se caracteriza por dolor en la cintura escapular, región cervicaly caderas, asociado frecuentemente a rigidez de estas áreas articulares posterior a periodosde reposo. El diagnóstico de esta patología es clínico y debe hacerse posterior a descartarotras entidades como artritis reumatoide o espondiloartropatía de aparición tardía. Hastael momento, no hay criterios de clasificación estandarizados y aceptados, por lo que recientementese desarrollaron unos criterios provisionales por parte del Colegio Americano deReumatología y de la Liga Europea Contra el Reumatismo. La polimialgia reumática se asociahasta en un 30% de los pacientes con arteritis de células gigantes. El principal tratamientoes con dosis bajas de glucocorticoides, con lo cual los pacientes presentan rápida mejoríasintomática...

Polymyalgia rheumatica following paraspinal muscle inflammation and sacroiliitis

No abstract available.

Clinical Implication of 18F-FDG-PET in Diagnosing and Monitoring Disease Activity in a Case of Subclinical Stage of Giant Cell Arteritis

Giant cell arteritis (GCA) is a systemic vasculitis which typically occurs in persons over 50 years old. GCA is closely related to polymyalgia rheumatica (PMR). A temporal artery biopsy is the gold standard test for the diagnosis of GCA. Recently, there is increasing evidence for the role of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in diagnosis of vasculitis. Here, we report on a case of a 67-year-old Korean male who was diagnosed with atypical GCA in subclinical stage concomitant with PMR by 18F-FDG-PET. After treatment, abnormal findings of 18F-FDG-PET were improved.

Localized Mesenteric Vasculitis in a Patient with Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an uncommon disorder characterized by bilateral pain and stiffness in the shoulder and pelvic girdles. Polymyalgia rheumatica and giant cell arteritis (GCA) occur in the same patient population and share a common pathogenesis. Giant cell arteritis predominantly affects the cranial arteries and rarely involves the gastrointestinal tract. Moreover, giant cell arteritis has rarely been reported in Asians. Here, we present a case with 62-year-old Asian woman who developed polymyalgia rheumatica with localized vasculitis in the mesenteric arteries.

Successful treatment with clarithromycin for patients with polymyalgia rheumatica

No abstract available.

Diagnosis and Treatment of Polymyalgia Rheumatica / 대한내과학회지

Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder that usually affects adults over 50 years of age. It is characterized by pain and stiffness of the neck, shoulders and hips. Laboratory tests have shown marked elevation of acute phase reactants (ESR and CRP), but there is no specific test to diagnose PMR. Recently, the European League Against Rheumatism and the American College of Rheumatology jointly proposed a new set of classification criteria for PMR. The mainstay of PMR treatment is low-dose glucocorticoids (prednisolone 10-20 mg/day). patients with PMR usually respond very well to steroid therapy within a few days to one week, but will often relapse despite treatment.

Epidemiology of Polymyalgia Rheumatica in Korea

OBJECTIVE: Polymyalgia rheumatica is a chronic inflammatory disease that affects people older than 50 years of age. The diagnosis is made based on clinical features, and the current standard of treatment is low-dose glucocorticoids. PMR is more commonly reported in Caucasians and females. However, epidemiological studies of PMR in Asian countries are scarce. We aimed to estimate the epidemiology of PMR in Korea. METHODS: This study was conducted by analyzing the Health Insurance Review and Assessment databases. We verified all claims between 2007 and 2012. Cases were included when PMR ICD-10 code (M 35.3) was recorded more than twice, and glucocorticoids were prescribed for > or =30 days. RESULTS: We identified 1,463 newly diagnosed cases of PMR during the 5 years. Among them, 992 (67.8%) were female, and the mean age at diagnosis was 66.9 years old. The annual incidence rate was 2.06 per 100,000 individuals aged over 50 years. The prevalence rate was 8.21 per 100,000 individuals in 2012. Incidence and prevalence appeared to increase with age. Prednisolone was the most commonly prescribed glucocorticoid. In half of the patients, the daily starting dose was 6~15 mg as prednisolone equivalents. CONCLUSION: This is the first study to investigate the epidemiology of PMR in Korea. The incidence and prevalence appeared to be considerably lower than those in Western populations. Both genetic and environmental factors might influence disease occurrence. In addition, the actual incidence may have been underestimated due to lack of awareness of PMR in clinical practice.

Typical 18-FDG-PET/CT Findings of Polymyalgia Rheumatica: A Case Report

Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized by generalized pain and morning stiffness in the shoulders, hip girdle, and neck. Since the pathogenesis of PMR is still uncertain, the diagnosis of PMR depends on clinical features. There have been several studies regarding radiological tools for the diagnosis of PMR. Recent studies using 18-FDG-PET showed bursitis, synovitis, uptake in the spinous process and asymptomatic large-vessel vasculitis in PMR patients. However, there was no report on the efficacy of 18-FDG-PET for diagnosis of PMR in Korea. Here, we are first reporting a case of a Korean patient with PMR, who had radiological findings including bursitis, synovitis, uptake in the spinous process and asymptomatic large-vessel vasculitis on 18-FDG-PET/CT.

Induction of Remission is Difficult due to Frequent Relapse during Tapering Steroids in Korean Patients with Polymyalgia Rheumatica

Polymyalgia rheumatica is an inflammatory disease affecting elderly and involving the shoulder and pelvic girdles. No epidemiological study of polymyalgia rheumatica was conducted in Korea. We retrospectively evaluated patients with polymyalgia rheumatica followed up at the rheumatology clinics of 10 tertiary hospitals. In total 51 patients, 36 patients (70.6%) were female. Age at disease onset was 67.4 yr. Twenty-three patients (45.1%) developed polymyalgia rheumatica in winter. Shoulder girdle ache was observed in 45 patients (90%) and elevated erythrocyte sedimentation rate (> 40 mm/h) in 49 patients (96.1%). Initial steroid dose was 23.3 mg/d prednisolone equivalent. Time to normal erythrocyte sedimentation rate was 4.1 months. Only 8 patients (15.7%) achieved remission. Among 41 patients followed up, 28 patients (68.3%) had flare at least once. Number of flares was 1.5 +/- 1.6. The frequency of flare was significantly lower in patients with remission (P = 0.02). In Korea, polymyalgia rheumatica commonly develops during winter. Initial response to steroid is fairly good, but the prognosis is not benign because remission is rare with frequent relapse requiring long-term steroid treatment.