Polymyalgia rheumatica - from knowledge to practice

Abstract

Despite the well known clinical picture, polymyalgia rheumatica remains a big diagnostic problemfor the general practice doctors, since it is often leads to the wrong. way of diagnostics. In order to diagnose polymyalgia rheumatica a doctor needs to exclude a lot of other potential diseases with similar symptoms and the patients undergo plenty of sometimes invasive diagnostic procedures. This disease affects people over than 50 years old. It has acute onset and characterized by proximal myalgia of the hip and shoulder girdles accompanying with morning stiffness that lasts for more than 1 hour, as well as inflammatory laboratory picture. The diagnosis established clinically after a thorough differential diagnosis. Sometimes it becomes the «diagnosis of exclusion». In this case the decisive criterion is a quick complete or near-complete symptoms resolution from the trial treatment with the low dose corticosteroids. The modern classification criteria and mane provisions for treatment of polymyalgia rheumatica are presented in this article. Three clinical cases from the internal medicine department practice are presented in this article, which demonstrate the difficulties in diagnosis in elderly patients. First case is a woman 63 years old who complies of fatigue, spontaneous weight reduction, fever which is accompanied by a pronounced laboratory signs of inflammation. Polymyalgia rheumatica was diagnosed as an «diagnosis of exclusion» after one month of conducting different diagnostic procedures and other specialists consultations. Trial corticosteroid therapy leaded to complete relapse of the symptoms which proved the diagnosis. Third and second cases demonstrate how the knowledge of clinical symptoms of polymyalgia rheumatica based on experience, allows one to establish the diagnose and to treat effectively comorbid patients. It helps significantly to improve quality of life.

Keywords

polymyalgia rheumatica / inflammatory systemic diseases / diagnosis / differential diagnosis / pain / muscle stiffness / arthritis / synovitis / bursitis / juicy arthritis / corticosteroids / metotrexat / clinical case

References

[1] Овчаренко, С.И. Сложности диагностики ревматической полимиалгии / С.И. Овчаренко [и др.] // Трудный пациент. - 2008. - № 6 (10). - С. 23-26.

[2] Овчаренко, С.И. Ревматическая полимиалгия: сложности диагностики / С.И. Овчаренко, И.С. Щедрина, М.П. Троицкая // Лечащий врач. - 2011. - № 4. - С. 33-36.

[3] Терещенко, И.В. Ревматическая полимиалгия и гигантоклетоный височный артериит / И. В. Терещенко // Клиническая медицина. - 2005. - № 8. - С. 25-30.

[4] Cantini, F. Erythrocyte sedimentation rate and C-reactive protein in the diagnosis of polymyalgia rheumatica / F. Cantini, C. Salvarani, I. Olivieri // Ann. Intern. Med. - 1998. - № 128. - Р 873-874.

[5] Cimmino, M.A. Epidemiology of polymyalgia rheumatica / M.A.Cimmino, A. Zaccaria // Clin. Exp. Rheumatol. - 2000. - № 18 (Suppl 20). - Р. 9-11.

[6] Dasgupta, B. 2012 рrovisional classification criteria for Rheumatology collaborative initiative Against Rheumatism / American College of polymyalgia rheumatica: a European League / Bhaskar Dasgupta [et al.] // Ann. Rheum. Dis. - 2012. - № 71. - Р. 484-492.

[7] Dejaco, C. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism. American College of Rheumatology collaborative initiative / C. Dejaco [at al.] // Ann. Rheum. Dis. - 2015. - № 74 (10). - Р. 1799-1807.

[8] Doran, M.F. / Trends in the incidence of polymyalgia rheumatic over a 30 year period in Olmsted County, Minnesota, USA / M.F. Doran [et al.] // J. Rheumatol. - 2002. - № 29. - Р 1694-1697.

[9] Salvarani, C. Polymyalgia rheumatica and giant-cell arteritis /C. Salvarani [et al.] // N. Engl. J. Med. - 2002. - № 347. - P 261-271.

[10] Salvarani, C. Polymyalgia rheumatica and giant-cell arteritis / C. Salvarani, F. Cantini, G.G. Hunder // Lancet. - 2008. - № 372 (9634). - Р. 234-245.

[11] Weyand, C.M. Giant-cell arteritis and polymyalgia rheumatica / C.M. Weyand, J.J. Goronzy // Ann. Intern. Med. - 2003. - № 139. - Р 505-15.

[12] Zimmermann Gorska, I. Polymyalgia rheumatica: clinical picture and principles of treatment / I. Zimmermann Gorska // Ann. Intern. Med. - 2007. - № 141. - Р 568-569.