An update on polymyalgia rheumatica

Ingrid E. Lundberg; Ankita Sharma; Carl Turesson; Aladdin J. Mohammad

doi:10.1111/joim.13525

journal article Open Access Jun 11, 2022

An update on polymyalgia rheumatica

Ingrid E. Lundberg

Ankita Sharma

Carl Turesson Aladdin J. Mohammad

Journal of Internal Medicine Vol. 292 No. 5 pp. 717-732 · Wiley

View at Publisher Save 10.1111/joim.13525

Abstract

AbstractPolymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease affecting people older than 50 years and is 2–3 times more common in women. The most common symptoms are pain and morning stiffness in the shoulder and pelvic girdle and the onset may be acute or develop over a few days to weeks. General symptoms such as fatigue, fever and weight loss may occur, likely driven by systemic IL‐6 signalling. The pathology includes synovial and periarticular inflammation and muscular vasculopathy. A new observation is that PMR may appear as a side effect of cancer treatment with checkpoint inhibitors. The diagnosis of PMR relies mainly on symptoms and signs combined with laboratory markers of inflammation. Imaging modalities including ultrasound, magnetic resonance imaging and positron emission tomography with computed tomography are promising new tools in the investigation of suspected PMR. However, they are still limited by availability, high cost and unclear performance in the diagnostic workup. Glucocorticoid (GC) therapy is effective in PMR, with most patients responding promptly to 15–25 mg prednisolone per day. There are challenges in the management of patients with PMR as relapses do occur and patients with PMR may need to stay on GC for extended periods. This is associated with high rates of GC‐related comorbidities, such as diabetes and osteoporosis, and there are limited data on the use of disease‐modifying antirheumatic drugs and biologics as GC sparing agents. Finally, PMR is associated with giant cell arteritis that may complicate the disease course and require more intense and prolonged treatment.

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Details

Published: Jun 11, 2022
Vol/Issue: 292(5)
Pages: 717-732
License: View

Authors

I

Ingrid E. Lundberg

Division of Rheumatology Department of Medicine Solna, Karolinska Institutet and Rheumatology Karolinska University Hospital Stockholm Sweden

A

Ankita Sharma

Rheumatology, Department of Clinical Sciences, Malmö Lund University Malmö Sweden

C

Carl Turesson

Rheumatology, Department of Clinical Sciences, Malmö Lund University Malmö Sweden; Department of Rheumatology Skåne University Hospital Lund‐Malmö Sweden

A

Aladdin J. Mohammad

Department of Rheumatology Skåne University Hospital Lund‐Malmö Sweden; Rheumatology, Department of Clinical Sciences, Lund Lund University Lund Sweden; Department of Medicine University of Cambridge Cambridge UK

Cite This Article

Ingrid E. Lundberg, Ankita Sharma, Carl Turesson, et al. (2022). An update on polymyalgia rheumatica. Journal of Internal Medicine, 292(5), 717-732. https://doi.org/10.1111/joim.13525

An update on polymyalgia rheumatica

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