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Genetic and environmental factors in polymyalgia rheumatica
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Introduction |
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Polymyalgia rheumatica (PMR) is a disease that
rheumatologists feel confident in recognising in their daily practice.
In the classic form, its diagnosis is straightforward and standard
corticosteroidal treatment usually yields excellent results, at least
in the first months. In contrast with the feeling that PMR is a disease
that can be readily treated, the aetiology and pathogenesis are still obscure. Unlike several other forms of rheumatic disease, we do not
know what the target of inflammation is in PMR. The synovial membrane
is the most probable candidate as synovitis has been demonstrated by
sonographic1 and immunohistochemical2 methods.
In addition, the frequent occurrence of peripheral arthritis in
patients with PMR further supports this possibility.3
Synovitis is mild and patchy in extent, which does not explain the
amount of inflammation disclosed by symptoms and laboratory tests. The skeletal muscle was considered the main site of inflammation by Barber4 who coined the name
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