The polymyalgia rheumatica is a syndrome that closely with giant cell arteritis (temporal arteritis) is associated. It affects adults> 55 years, and typically causes severe pain and stiffness in proximal muscles without weakness or atrophy, and nonspecific systemic symptoms. ESR and CRP are usually increased. The diagnosis is made clinically. Treatment with low-dose corticosteroids is effective. A dramatic and rapid response to low to moderate doses of prednisone or methylprednisolone supports the diagnosis.
The polymyalgia rheumatica affects adults> 55 years; the ratio of women to men is 2: 1.
The polymyalgia rheumatica is a syndrome that closely with giant cell arteritis (temporal arteritis) is associated. It affects adults> 55 years, and typically causes severe pain and stiffness in proximal muscles without weakness or atrophy, and nonspecific systemic symptoms. ESR and CRP are usually increased. The diagnosis is made clinically. Treatment with low-dose corticosteroids is effective. A dramatic and rapid response to low to moderate doses of prednisone or methylprednisolone supports the diagnosis. The polymyalgia rheumatica affects adults> 55 years; the ratio of women to men is 2: 1. Since the polymyalgia rheumatica is closely associated with giant cell arteritis, the two diseases by some experts as different aspects of one and the same process is viewed. The polymyalgia rheumatica appears to be more common than the giant. Some patients with polymyalgia rheumatica also develop giant cell arteritis, however, 40-60% of patients with giant cell arteritis also have polymyalgia rheumatica. The polymyalgia rheumatica may precede giant cell arteritis, follow or occur simultaneously with it. Etiology and pathogenesis are unknown. Ultrasound and MRI findings suggest that this is likely axial by a mild synovitis and bursitis are related. The symptoms and complaints polymyalgia rheumatica is characterized by bilateral proximal pain in the shoulder and Hüftgürtelbereich and in the back (upper and lower) and neck muscles. Morning stiffness is typical and lasts> 60 min. The shoulder symptoms go (subdeltoid z. B., subakromial) to a proximal bursitis and rarely returned to inflammation of the biceps tendon or joint synovitis. The symptoms are worse in the morning and occasionally so severe that they prevent the patient getting up out of bed and to perform simple tasks. The pain can feel weak patients, however, the muscle weakness is not an objective characteristic of the disease. Diagnosis Clinical findings rule out other causes of the suspected polymyalgia rheumatica is in elderly patients with typical symptoms, but other possible causes must be ruled out. The tests include ESR, CRP, blood count, TSH levels and creatine kinase. In> 80% of patients, the BSG is increased, often> 100 mm / h (normal value> 50 mm / h according to Westergren). The CRP is also increased. Electromyography, biopsy and other tests (eg. As rheumatoid factor) are normal in polymyalgia rheumatica, but sometimes lead to other clinically suspected diagnoses. The following findings limit the polymyalgia rheumatica from other disorders: RA: When polymyalgia rheumatica chronic arthritis of small joints, erosive or destructive lesions, rheumatoid nodules and rheumatoid factor missing at about 80% of patients (although joint swelling may be present). The remaining 20% ??of the differentiation is difficult from an RA. Polymyositis: When polymyalgia rheumatica outweighs pain instead of weakness; Muscle enzyme levels and electromyography and muscle biopsy findings are normal. Hypothyroidism: When polymyalgia rheumatica Schilddrüsenfunktionsts and muscle enzyme levels are normal. Multiple Myeloma: In polymyalgia rheumatica missing a monoclonal gammopathy. Fibromyalgia: The polymyalgia rheumatica symptoms are more localized, the ESR is usually increased and pain in the shoulders are present in sensing and movement (active and passive), even if the patient is distracted. Prednisone therapy The administration of prednisone beginning at 15-20 mg p.o. once a day, often very quickly (in hours or days) leads to dramatic improvements, and the response will help to secure the diagnosis. When a giant is suspected, the corticosteroid dose should be increased and there should be a biopsy of the temporal artery. The effectiveness of the treatment is controlled by symptoms, ESR and CRP. After symptoms corticosteroids to the lowest clinically wirsame dose should be reduced. In reviewing the response to treatment CRP is useful as an SPA since the ESR may be elevated permanently in the elderly for other reasons. Some patients may terminate within about 2 years without recurrence even earlier the corticosteroid, another part will have to maintain low doses for several years. NSAIDs are rare enough. Some patients in whom a tapering off of the prednisone dose is not possible and have frequent recurrences, benefit from an additional dose of methotrexate (10-15 mg po once a week, when renal function is normal) or another immunosuppressant such as azathioprine. The addition of a second drug in polymyalgia rheumatica or giant cell arteritis is controversial because randomized controlled studies have shown only a small benefit. Experiments with anti-TNF drugs (infliximab and adalimumab) and rituximab have shown no benefit. In elderly patients, the physician should pay attention to complications of corticosteroid use (eg., Diabetes, hypertension) and treat them. Patients with Dauerkortikosteroidtherapie should receive bisphosphonates for prevention of osteoporosis. A giant can rheumatica develop at the beginning of polymyalgia or much later, sometimes even if the patients appear to be cured of the disease. Therefore, all patients should be advised to set of headaches, muscle pain during chewing and especially about vision problems their doctors immediately informed. Summary polymyalgia rheumatica affects adults> 55 years, leading to proximal muscle pain and stiffness. It is present in 40-60% of patients with giant cell arteritis. The diagnosis is clinically found sometimes with supporting evidence of increased ESR and dramatic response to low doses of corticosteroids. The treatment consists of the administration of corticosteroids, which can eventually be tapered when, and methotrexate or azathioprine if needed. Patients should be informed about symptoms of giant cell arteritis.