These include polymyositis, drug-induced myopathies e.
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With such patients, a C-reactive protein CRP level may be useful. An additional criterion: prompt response to daily treatment with at least 20 mg of prednisone. New-onset headache or scalp pain in any patient older than 50 years of age must raise clinical suspicion of GCA. Jaw claudication, generally characterized as fatigue and pain of the muscles of mastication, is one of the most specific signs of GCA. Initial presentation may be of transient visual loss or amaurosis fugax.
Polymyalgia Rheumatica and Giant Cell Arteritis | Josef Rovensky | Springer
Diplopia may also be an early manifestation of GCA. Biopsy of the temporal artery remains the standard for diagnosis of GCA and should be performed in any patient with a high suspicion of GCA. Positive biopsy findings typically show granulomatous inflammation of the vessel wall with infiltration of multinucleated giant cells, macrophages, and T cells.
Corticosteroids are the cornerstone of treatment of PMR. The usual starting dose of prednisone is 10 to 20 mg daily. This is continued for 1 month and is carefully tapered by 1 to 2. The dosage may be further tapered by 1 mg every 4 to 6 weeks to a maintenance dose of 5 to 7.
Failure to achieve a prompt and complete response to corticosteroid therapy should initiate a search by the clinician for a different cause of the symptoms, such as another rheumatic condition or an occult malignancy. Discontinuation of steroids may be attempted after 6 to 12 months if the ESR has normalized and the patient is symptom free. This is usually accomplished by continuing to taper the dosage by 1 mg every 6 to 8 weeks.
Relapses are most common in the first 18 months of therapy. The starting dose of glucocorticoids for GCA patients has not been definitively established. The current recommendation is to start these patients on 40 to 60 mg of prednisone daily. The average GCA patient requires 24 or more months of corticosteroid treatment.
Perform a complete history and physical examination, particularly of the cervical and lumbar spine and nerve roots strength, sensation, and deep tendon reflexes in the distal limbs should be intact with polymyalgia rheumatica [PMR]. Eliza F. Classically, this condition responds to moderate doses of prednisone within 48 hours. A variety of other conditions can have presentations that mimic polymyalgia rheumatica, including other rheumatic disorders, systemic infections, and malignancy.
Kidney, lung, and colon cancer and multiple myeloma are most often found in patients presenting with atypical polymyalgia rheumatica. Samera Vaseer, Eliza F. Polymyalgia rheumatica , a disorder affecting older adults, manifests with discomfort and stiffness in the shoulder and hip girdle, fatigue, anemia of chronic disease, and elevated erythrocyte sedimentation rate ESR.
Polymyalgia Rheumatica and Giant Cell Arteritis
Classically this condition responds to moderate doses of prednisone within 48 hours. Robert A. Duarte MD, Charles E. The cause of the condition is not known. Recent research has indicated that genetic inherited risk factors play a role in who becomes afflicted with the illness.
Theories include viral stimulation of the immune system in genetically susceptible individuals. Rarely, the disease is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms. What are common symptoms and signs of polymyalgia rheumatica?
The onset of the disease can be sudden. A patient may have a healthy history until awakening one morning with stiffness and pain of muscles and joints throughout the body, particularly in the upper arms, hips, neck, and shoulders.
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These pains can lead to a sensation of weakness and loss of function. Sometimes there is also muscle tenderness with PMR. These clinical symptoms persist and often include an intense sensation of fatigue. Some patients notice a gradual loss of appetite accompanied by weight loss and lack of energy. Depression can occur. How do health care professionals make a diagnosis of polymyalgia rheumatica?
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The diagnosis of the disorder is suggested by the health history and physical examination. A health care professional frequently notes muscle tenderness and that the motion of the shoulders is limited by pain. The joints are usually not swollen. There are no specific tests, however, for the condition and X-rays are normal. The diagnosis is based on the characteristic history of persisting muscle and joint pain and stiffness associated with elevated blood tests for inflammation, such as the ESR.
It is also not unusual for patients to have slight elevations of liver blood tests. What is the medical treatment for polymyalgia rheumatica? Doctors direct their medical treatment of PMR toward reducing pain and inflammation. While some patients with mild symptoms can improve with nonsteroidal anti-inflammatory drugs NSAIDs such as aspirin or ibuprofen Motrin , Advil , most patients respond best to low doses of corticosteroids such as prednisone or prednisolone.
Not infrequently, a single day of cortisone medicine eases many of the symptoms! In fact, the rapid, gratifying results with low dose corticosteroids is characteristic of the condition.
Polymyalgia Rheumatica and Giant Cell Arteritis
The corticosteroid dose is gradually reduced while the doctor monitors the symptoms and normalization of the blood ESR. Reactivation of symptoms can require periodic adjustments in the prednisone dosage. Most patients are able to completely wean from the corticosteroid within several years. Some patients require longer-term medical treatment. Occasionally, patients have recurrence years after the symptoms have resolved.
The ideal prednisone dosing regimen continues to be sought by clinical researchers. What is the prognosis for patients with polymyalgia rheumatica? One of the keys to successful treatment of polymyalgia rheumatica is gradual, and not rapid, tapering of the medicines.
This can avoid unwanted flare-ups of the disease. Because the medicines prednisone and prednisolone are associated with potential bone toxicity, causing osteoporosis , patients should consider calcium and vitamin D supplementation. Bone mineral density testing should be performed in appropriate patients, and doctors may consider prescribing osteoporosis medicines, such as estrogen, alendronate Fosamax , and risedronate Actonel for some.
Is it possible to prevent polymyalgia rheumatica? There is no prevention for polymyalgia rheumatica.
Prevention measures focus on preventing side effects of drugs used to treat polymyalgia rheumatica. What are polymyalgia rheumatica complications? Polymyalgia rheumatica can lead to loss of function of joints if untreated. This generally is temporary, but frozen shoulders can be a further medical complication. Additional complications can result from medications used to treat polymyalgia rheumatica. These include stomach bleeding or kidney impairment from nonsteroidal anti-inflammatory drugs and cataracts , bruising of skin, and osteoporosis from cortisone medications.