Polymyalgia rheumatica

doi:10.1016/S0140-6736(17)31825-1

The Lancet

Volume 390, Issue 10103, 7–13 October 2017, Pages 1700-1712

https://doi.org/10.1016/S0140-6736(17)31825-1 Get rights and content

Summary

Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. Vascular uptake on PET scans is seen in some patients. A dose of 12·5–25·0 mg prednisolone daily or equivalent leads to rapid improvement of symptoms in most patients with isolated disease. However, relapses are common when prednisolone is tapered. Methotrexate might be used in patients who relapse. The effectiveness of biological therapies, such as anti-interleukin 6, in patients with polymyalgia rheumatica that is refractory to glucocorticoids requires further investigation. Most population-based studies indicate that mortality is not increased in patients with isolated disease.

Introduction

Polymyalgia rheumatica is an inflammatory disorder characterised by severe pain and stiffness affecting the shoulders and proximal aspects of the arms bilaterally. Pain and stiffness is also common in the neck. Less frequently these symptoms affect the pelvic girdle and the proximal aspects of the thighs. Patients have morning stiffness that lasts more than 45–60 min and non-specific symptoms such as fatigue and malaise. Increases in acute phase reactants (ie, erythrocyte sedimentation rate and C-reactive protein) is a characteristic feature of the disease.¹

Bruce first described this condition in 1888.² Polymyalgia rheumatica—also known as secondary fibrositis, periarthrosis humeroscapularis, peri-extra-articular rheumatism, myalgic syndrome of the aged, pseudo-polyarthrite rhizomelique, and anarthritic rheumatoid disease—was first reported in the 1940s. The term polymyalgia rheumatica was introduced by Barber in 1957.²

Section snippets

Epidemiology: incidence, genetic components, and environmental factors

Polymyalgia rheumatica is a common disease in elderly patients, but rarely arises in individuals younger than 50 years.³ More than two-thirds of patients are women. Incidence increases progressively with age in both sexes until the age of 80 years.⁴ The highest incidence is in people older than 65 years, with a peak in the 70–79 year age group.³ Polymyalgia rheumatica is most common in Scandinavian countries.5, 6 The mean annual incidence of polymyalgia rheumatica in individuals aged older than

Pathophysiology

Arthroscopic studies have shown the presence of mild synovitis in the proximal joints (mainly in the shoulders) of patients with polymyalgia rheumatica. The inflammatory infiltrate found in the shoulder synovial membranes and other affected joints was composed mainly of macrophages and CD4 T lymphocytes.¹⁹ This mild synovitis does not fully explain the musculoskeletal manifestations and the diffuse pain in the periarticular structures. In view of the prominent inflammatory involvement of

Clinical manifestations

The cardinal clinical feature of polymyalgia rheumatica is pain with restricted range of motion and stiffness of the shoulder girdle in patients older than 50 years. Patients often complain of pain and stiffness in the upper arms, neck, pelvic girdle, hips, and thighs.³¹ These clinical manifestations are usually bilateral. The onset of symptoms is often rapid, generally over a few days and in some cases acutely overnight. Symptoms are associated with aching and early morning stiffness in the

Laboratory abnormalities

Rises in acute phase reactants is a typical feature in patients with polymyalgia rheumatica. An erythrocyte sedimentation rate of 40 mm or higher per h is regarded as a classification criterion by some34, 43, 44 (panel). Other authors recommend an erythrocyte sedimentation rate of more than 30 mm per h or a C-reactive protein concentration of more than 6 mg/L as a classification criterion for polymyalgia rheumatica diagnosis.⁴⁵ The 2012 European League Against Rheumatism (EULAR) and the

Polymyalgia rheumatica and giant cell arteritis

Giant cell arteritis is a large blood vessel vasculitis that occurs in elderly people.1, 3 This condition is uncommon in people younger than 50 years and incidence of the disease peaks in the 70–79-year age group.3, 53 Similar to polymyalgia rheumatica, giant cell arteritis has a strong genetic association with the HLA-class region and the disease has a high prevalence in Scandinavian countries and in individuals of Scandinavian descent.3, 13, 14

Giant cell arteritis and polymyalgia rheumatica

Mimics of polymyalgia rheumatica

Symptoms of polymyalgia rheumatica are non-specific and many disease mimics exist. Clinicians should be aware of the most common conditions that mimic polymyalgia rheumatica, including rheumatoid arthritis, shoulder osteoarthritis, polyarticular calcium pyrophosphate deposition disease, rotator cuff disease, and adhesive capsulitis (frozen shoulder).

Additional information about conditions that mimic polymyalgia rheumatica is shown in the table and appendix.32, 37, 38, 39, 40, 63, 64, 65, 66, 67

Diagnostic investigations and classification criteria

Several sets of criteria for the classification and diagnosis of polymyalgia rheumatica have been proposed (panel). The criteria have common features, such as older age (≥50 years), typical involvement of shoulders, and the presence of raised acute phase reactants.34, 38, 43, 44, 45 The criterion of older age (>50 years) was proposed by Chuang and colleagues,³⁴ Healey,⁴⁴ and the 2012 EULAR/ACR criteria.38, 78 Bilateral clinical involvement that predominantly involves the shoulders with morning

Management of polymyalgia rheumatica

Oral prednisolone is the mainstay of treatment in polymyalgia rheumatica.89, 90, 91

A prednisolone dose ranging between 12·5 and 25 mg per day is sufficient to yield rapid improvement of polymyalgia features in most cases.28, 51, 89, 92, 93 However, the dose might be individualised according to each patient. Although the biological activity of glucocorticoids is certainly not only bodyweight dependent, generally a heavy person (>80 kg) without risk factors for side-effects such as diabetes

Relapses

Relapses are defined as the recurrence of polymyalgia rheumatica symptoms that are generally associated with elevation rise in erythrocyte sedimentation rate and C-reactive protein concentration. Persistently high concentrations of C-reactive protein and interleukin 6 were significantly associated with an increased risk of relapse in patients with polymyalgia rheumatica.¹²⁰ This association was especially evident for patients with persistently high concentrations of interleukin 6 during the

Comorbidities and outcomes

Most patients with polymyalgia rheumatica have side-effects associated with glucocorticoid therapy that depend on the duration of treatment and the cumulative dose.¹²⁶ Nevertheless, overall cardiovascular mortality does not seem increased in this disease.127, 128 Although patients with isolated disease were reported to be at increased risk for peripheral artery disease,¹²⁹ and polymyalgia rheumatica was associated with higher risk for stroke in Chinese individuals,¹³⁰ a large registry study of

Controversies in polymyalgia rheumatica management

No unanimous consensus has been reached on the optimum dose of glucocorticoids to prescribe for patients with isolated polymyalgia rheumatica. Experts from the 2015 EULAR and ACR collaborative initiative92, 93 proposed an initial prednisolone dose between 12·5–25·0 mg daily or equivalent. This group of experts recommends a single dose of prednisolone.92, 93 However, we believe that an initial divided dose might be more effective to improve stiffness and pain in the morning when the patient is

Future directions and research questions

Management recommendations should take into account patient perspectives. One way to achieve this is to focus on the severity rather than on the duration of morning stiffness, especially at the time of diagnosis because patients usually find it difficult to measure the exact duration of stiffness.

In addition to a definitive biomarker for diagnosis of polymyalgia rheumatica, better markers of disease activity are needed. These biomarkers could be serological and imaging techniques that might be

Search strategy and selection criteria

We searched the Cochrane Library and PubMed for reports published in English from database inception until Feb 28, 2017, using the term “polymyalgia rheumatica” AND each heading used in our Seminar (eg, “epidemiology”; “genetics”; “pathophysiology”…). We largely selected publications from the past 10 years, but did not exclude commonly referenced and highly regarded older publications. We also searched the reference lists of articles identified by this search strategy and selected those we

References (135)

GG Hunder
The early history of giant cell arteritis and polymyalgia rheumatica: first descriptions to 1970
Mayo Clin Proc
(2006)
FD Carmona et al.
A large-scale genetic analysis reveals a strong contribution of the HLA class II region to giant cell arteritis susceptibility
Am J Hum Genet
(2015)
MA González-Gay et al.
Genetic markers of disease susceptibility and severity in giant cell arteritis and polymyalgia rheumatica
Semin Arthritis Rheum
(2003)
TA Kermani et al.
Polymyalgia rheumatica
Lancet
(2013)
LA Healey
Long-term follow-up of polymyalgia rheumatica: evidence for synovitis
Semin Arthritis Rheum
(1984)
N Pipitone et al.
Update on polymyalgia rheumatica
Eur J Intern Med
(2013)
MA Gonzalez-Gay
Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions
Semin Arthritis Rheum
(2004)
C Lavado-Pérez et al.
18F-FDG PET/CT for the detection of large vessel vasculitis in patients with polymyalgia rheumatica
Rev Esp Med Nucl Imagen Mol
(2015)
J Loricera et al.
Use of positron emission tomography (PET) for the diagnosis of large-vessel vasculitis
Rev Esp Med Nucl Imagen Mol
(2015)
C Salvarani et al.
Polymyalgia rheumatica and giant-cell arteritis
Lancet
(2008)

EL Matteson et al.

Glucocorticoids for management of polymyalgia rheumatica and giant cell arteritis

Rheum Dis Clin North Am

(2016)

C Salvarani et al.

Polymyalgia rheumatica and giant-cell arteritis

N Engl J Med

(2002)

MA Gonzalez-Gay et al.

Epidemiology of giant cell arteritis and polymyalgia rheumatica

Arthritis Rheum

(2009)

S Raheel et al.

Epidemiology of polymyalgia rheumatica 2000–2014 and examination of incidence and survival trends over 45 years: a population based study

Arthritis Care Res

(2016)

P Boesen et al.

Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county: a prospective investigation, 1982–1985

Arthritis Rheum

(1987)

P Elling et al.

Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; association with epidemics of Mycoplasma pneumoniae infection

J Rheumatol

(1996)

C Schaufelberger et al.

Epidemiology and mortality in 220 patients with polymyalgia rheumatica

Br J Rheumatol

(1995)

MF Doran et al.

Trends in the incidence of polymyalgia rheumatic over a 30 year period in Olmsted County, Minnesota, USA

J Rheumatol

(2002)

C Salvarani et al.

Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in northern Italy

Arthritis Rheum

(1991)

MA Gonzalez-Gay et al.

The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a 10 year study

J Rheumatol

(1999)

CS Crowson et al.

Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatic

Semin Arthritis Rheum

(2017)

M Yates et al.

The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population

BMC Musculoskelet Disord

(2016)

L Boiardi et al.

Relationship between interleukin 6 promoter polymorphism at position -174, IL-6 serum levels, and the risk of relapse/recurrence in polymyalgia rheumatica

J Rheumatol

(2006)

MA Gonzalez-Gay et al.

IL-6 promoter polymorphism at position-174 modulates the phenotypic expression of polymyalgia rheumatica in biopsy-proven giant cellarteritis

Clin Exp Rheumatol

(2002)

P Peris

Polymyalgia rheumatica is not seasonal in pattern and is unrelated to parvovirus b19 infection

J Rheumatol

(2003)

RL Rhee et al.

Infections and the risk of incident giant cell arteritis: a population-based, case-control study

Ann Rheum Dis

(2017)

R Meliconi et al.

Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment

Arthritis Rheum

(1996)

C Salvarani et al.

Polymyalgia rheumatica: a disorder of extraarticular synovial structures?

J Rheumatol

(1999)

C Salvarani et al.

Proximal bursitis in active polymyalgia rheumatica

Ann Intern Med

(1997)

F Cantini et al.

Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study

J Rheumatol

(2001)

F Cantini et al.

Inflammatory changes of hip synovial structures in polymyalgia rheumatica

Clin Exp Rheumatol

(2005)

C Salvarani et al.

Cervical interspinous bursitis in active polymyalgia rheumatica

Ann Rheum Dis

(2008)

C Salvarani et al.

Lumbar interspinous bursitis in active polymyalgia rheumatica

Clin Exp Rheumatol

(2013)

MA Gonzalez-Gay

The clinical implication of cervical interspinous bursitis in the diagnosis of polymyalgia rheumatica

Ann Rheum Dis

(2008)

F Kreiner et al.

Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Arthritis Rheum

(2010)

MA González-Gay et al.

Giant cell arteritis and polymyalgia rheumatica: an update

Curr Rheumatol Rep

(2015)

M Samson et al.

Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis

Arthritis Rheum

(2012)

KS van der Geest et al.

Disturbed B cell homeostasis in newly diagnosed giant cell arteritis and polymyalgia rheumatica

Arthritis Rheumatol

(2014)

C Masson et al.

Polymyalgia rheumatica and giant cell arteritis

MA González-Gay et al.

Polymyalgia rheumatica in biopsy proven giant cell arteritis does not constitute a different subset but differs from isolated polymyalgia rheumatica

J Rheumatol

(1998)

TY Chuang et al.

Polymyalgia rheumatica: a 10-year epidemiologic and clinical study

Ann Intern Med

(1982)

MA Gonzalez-Gay et al.

Fever in biopsy-proven giant cell arteritis: clinical implications in a defined population

Arthritis Rheum

(2004)

MA González-Gay et al.

Polymyalgia rheumatica vs rheumatoid arthritis in the elderly

Arch Intern Med

(1997)

CT Pease et al.

Polymyalgia rheumatica can be distinguished from late onset rheumatoid arthritis at baseline: results of a 5-yr prospective study

Rheumatology

(2009)

B Dasgupta et al.

2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative

Arthritis Rheum

(2012)

C Salvarani et al.

Distal musculoskeletal manifestations in polymyalgia rheumatica

Arthritis Rheum

(1998)

MA Gonzalez-Gay et al.

Diagnostic approach in a patient presenting with polymyalgia

Clin Exp Rheumatol

(1999)

C Salvarani et al.

Distal extremity swelling with pitting edema in polymyalgia rheumatica. Report of nineteen cases

Arthritis Rheum

(1996)

DJ McCarty et al.

Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome

JAMA

(1985)

HA Bird et al.

An evaluation of criteria for polymyalgia rheumatica

Ann Rheum Dis

(1979)

Cited by (179)

Glucocorticoid treatment and clinical outcomes in patients with polymyalgia rheumatica: A cohort study using routinely collected health data
2024, Joint Bone Spine
We aimed to describe the following in patients with polymyalgia rheumatica (PMR): (1) real-world glucocorticoid (GC) therapy, (2) improvement in inflammatory parameters associated with disease activity (C-reactive protein [CRP] level and erythrocyte sedimentation rate [ESR]), and (3) incidence of GC-related adverse events (AEs).
A cohort study was conducted using a Japanese electronic medical records database. We included newly diagnosed PMR patients aged ≥ 50 years with baseline CRP levels ≥ 10 mg/L and/or ESR > 30 mm/h and an initial GC dose of ≥ 5 mg/day. The outcomes were GC dose, inflammatory parameters, and GC-related AEs.
A total of 373 PMR patients (mean age, 77.3 years) were analyzed. The median initial GC dose was 15.0 mg/day, which gradually decreased to 3.5 mg/day by week 52. The median cumulative GC dose at week 52 was 2455.0 mg. The median CRP level on day 0 was 64.3 mg/L, which decreased during weeks 4–52 (1.4–3.2 mg/L). At week 52, 39.0% of patients had a CRP level > 3.0 mg/L. The cumulative incidence of GC-related AEs at week 52 was 49.0% for osteoporosis, 30.2% for diabetes, 14.9% for hypertension, 12.2% for peptic ulcer, 11.3% for dyslipidemia, 2.9% for glaucoma, and 4.3% for serious infection. The incidence of osteoporosis and diabetes increased with the GC dose.
The incidence of GC-related AEs was associated with the GC dose in PMR patients. Further research is required to identify treatment strategies that can effectively control PMR disease activity while minimizing GC use.
Executive summary on the optimization of the multidisciplinary and integrated approach to polymyalgia rheumatica and giant cell arteritis in Madrid region
2024, Revista Clinica Espanola
La polimialgia reumática y la arteritis de células gigantes pueden suponer una emergencia médica en la que el retraso en su correcto diagnóstico y manejo terapéutico pueden asociar complicaciones graves.
Con el objetivo de mejorar la atención de los pacientes con estas patologías en el entorno de la Comunidad de Madrid, se diseñó un estudio para identificar las causas y las posibles soluciones para hacer frente los problemas relacionados con el diagnóstico de estas patologías.
Tras un análisis preliminar, se identificaron 11 áreas de mejora relacionadas con cuatro aspectos diferenciados del proceso asistencial: coordinación y protocolos, equipamientos, formación y concienciación sobre las patologías y experiencia del paciente. De todas ellas, se priorizó resolver aquellas relacionadas con la generación de protocolos de abordaje integral de las patologías y que contemplen todas las especialidades y niveles asistenciales implicados. Otro aspecto crucial es el incremento del grado de sospecha clínica de estas patologías.
Polymyalgia rheumatica and giant cell arteritis can be a medical emergency in which a delay in correct diagnosis and therapeutic management can cause serious complications.
With the aim of improving the care of patients with these pathologies in the Community of Madrid, a study was designed to identify the causes and possible solutions to address the problems related to the diagnosis of these pathologies.
After the analysis, 11 areas of improvement related to four different aspects of the care process were identified: coordination and protocols, equipment, training and awareness of pathologies, and patient experience. Of all the areas identified, it was considered a priority to resolve those related to the generation of protocols for the comprehensive management of the pathologies, which include all the specialties and levels of care involved. Another crucial aspect is the increase in the degree of clinical suspicion of these pathologies.
Early referral of patients with suspected polymyalgia rheumatica – A systematic review
2023, Seminars in Arthritis and Rheumatism
Prompt diagnosis and treatment of polymyalgia rheumatica (PMR) is crucial to prevent long-term complications and improve patient outcomes. However, there is currently no standardized approach to referral of suspected PMR patients to rheumatologists, leading to inconsistent management practices. The objective of this systematic review was to clarify the existing evidence regarding the following aspects of early management strategies in patients with suspected PMR: diagnostic strategies, GCA screening, glucocorticoid initiation prior to referral, value of shared care and value of fast track clinic.
Two authors performed a systematic literature search, data extraction and risk of bias assessment independently. The literature search was conducted in Embase, MEDLINE (PubMed) and Cochrane. Studies were included if they contained cohorts of suspected PMR patients and evaluated the efficacy of different diagnostic strategies for PMR, screening for giant cell arteritis (GCA), starting glucocorticoids before referral to secondary care, shared care, or fast-track clinics.
From 2,437 records excluding duplicates, 14 studies met the inclusion criteria. Among these, 10 studies investigated the diagnostic accuracy of various diagnostic strategies with the majority evaluating different clinical approaches, but none of them showed consistently high performance. However, 4 studies on shared care and fast-track clinics showed promising results, including reduced hospitalization rates, lower starting doses of glucocorticoids, and faster PMR diagnosis.
This review emphasizes the sparse evidence of early management and referral strategies for patients with suspected PMR. Additionally, screening and diagnostic strategies for differentiating PMR from other diseases, including concurrent GCA, require clarification. Fast-track clinics may have potential to aid patients with PMR in the future, but studies will be needed to determine the appropriate pre-referral work-up.
Pericardial and pleural effusion in a patient with giant cell arteritis
2023, Medicina Clinica
Polymyalgia rheumatica
2023, The Lancet
Polymyalgia rheumatica is an inflammatory disease producing pain and stiffness, mainly in the shoulders and pelvic girdle, in people older than 50 years. Elevation of acute phase reactants is common due to the inflammatory nature of the disease. Since there are no specific diagnostic tests, diagnosis requires the exclusion of other diseases with similar presentations. Imaging has helped to identify the pathological substrate of polymyalgia rheumatica and it is increasingly used to support clinical diagnosis or to detect coexistent giant cell arteritis. Although polymyalgia rheumatica does not clearly impair survival or organ function, it can have a detrimental effect on quality of life. Glucocorticoids at 12·5–25·0 mg prednisone per day are effective in inducing remission in most individuals but, when tapered, relapses occur in 40–60% of those affected and side-effects are common. Assessment of disease activity can be difficult because pain related to common comorbidities such as osteoarthritis and tendinopathies, can return when glucocorticoids are reduced, and acute phase reactants are increased less during flares in individuals undergoing treatment or might increase for other reasons. The role of imaging in assessing disease activity is not yet completely defined. In the search for more efficient and safer therapies, tocilizumab and sarilumab have shown efficacy in randomised controlled trials and additional targeted therapies are emerging. However, judicious risk–benefit balance is essential in applying therapeutic innovations to people with polymyalgia rheumatica.
Assessing the feasibility of SUVindex (a metric derived from FDG PET/CT) for the diagnosis of polymyalgia rheumatica
2023, Clinical Radiology
To evaluate the feasibility of standard uptake value (SUV) index (ratio lesional maximum SUV [SUVmax] to liver mean SUV [SUVmean]) as a metabolic parameter for diagnosing polymyalgia rheumatica (PMR).
A retrospective group of patients with PMR and controls with symptoms similar to PMR but diagnosed with other diseases. Semiquantitative and qualitative analysis of 2-[¹⁸F]-fluoro-2-deoxy-d-glucose (¹⁸F-FDG) uptake at 18 sites was undertaken for all patients. The diagnostic value of positron-emission tomography/computed tomography (PET/CT) for PMR was assessed by R software using logistic regression and a generalised additive model (GAM). All images were examined independently by two nuclear medicine physicians with extensive work experience.
The characteristic sites of PMR were the ischial tuberosity, interspinous bursa, periarticular hip, and symphysis pubis enthesis. The area under the curve (AUC) of the characteristic site SUV index was 0.930, and the best cut-off value was 1.685 with a sensitivity of 84.6% and a specificity of 92.6%. After adjusting for potential confounders, the probability of PMR diagnosis increased as the characteristic site SUV index increased and there was a nonlinear correlation between the two. When the characteristic site SUV index was ≥2.56, the probability of PMR gradually reached the threshold effect, which was as high as 90% or more.
The characteristic site SUV index is an independent factor for diagnosing PMR, and PMR should be highly suspected when it is ≥ 1.685. Nonetheless, it is important to note that these findings are based on an initial retrospective single-centre study and require external validation and further prospective evaluation before being translated into clinical practice.

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SeminarPolymyalgia rheumatica

Summary

Introduction

Section snippets

Epidemiology: incidence, genetic components, and environmental factors

Pathophysiology

Clinical manifestations

Laboratory abnormalities

Polymyalgia rheumatica and giant cell arteritis

Mimics of polymyalgia rheumatica

Diagnostic investigations and classification criteria

Management of polymyalgia rheumatica

Relapses

Comorbidities and outcomes

Controversies in polymyalgia rheumatica management

Future directions and research questions

Search strategy and selection criteria

Mayo Clin Proc

Am J Hum Genet

Semin Arthritis Rheum

Lancet

Semin Arthritis Rheum

Eur J Intern Med

Semin Arthritis Rheum

Rev Esp Med Nucl Imagen Mol

Rev Esp Med Nucl Imagen Mol

Lancet

Rheum Dis Clin North Am

Polymyalgia rheumatica and giant-cell arteritis

N Engl J Med

Epidemiology of giant cell arteritis and polymyalgia rheumatica

Arthritis Rheum

Epidemiology of polymyalgia rheumatica 2000–2014 and examination of incidence and survival trends over 45 years: a population based study

Arthritis Care Res

Giant cell arteritis, temporal arteritis, and polymyalgia rheumatica in a Danish county: a prospective investigation, 1982–1985

Arthritis Rheum

Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; association with epidemics of Mycoplasma pneumoniae infection

J Rheumatol

Epidemiology and mortality in 220 patients with polymyalgia rheumatica

Br J Rheumatol

Trends in the incidence of polymyalgia rheumatic over a 30 year period in Olmsted County, Minnesota, USA

J Rheumatol

Epidemiologic and immunogenetic aspects of polymyalgia rheumatica and giant cell arteritis in northern Italy

Arthritis Rheum

The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a 10 year study

J Rheumatol

Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatic

Semin Arthritis Rheum

The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population

BMC Musculoskelet Disord

Relationship between interleukin 6 promoter polymorphism at position -174, IL-6 serum levels, and the risk of relapse/recurrence in polymyalgia rheumatica

J Rheumatol

IL-6 promoter polymorphism at position-174 modulates the phenotypic expression of polymyalgia rheumatica in biopsy-proven giant cellarteritis

Clin Exp Rheumatol

Polymyalgia rheumatica is not seasonal in pattern and is unrelated to parvovirus b19 infection

J Rheumatol

Infections and the risk of incident giant cell arteritis: a population-based, case-control study

Ann Rheum Dis

Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment

Arthritis Rheum

Polymyalgia rheumatica: a disorder of extraarticular synovial structures?

J Rheumatol

Proximal bursitis in active polymyalgia rheumatica

Ann Intern Med

Shoulder ultrasonography in the diagnosis of polymyalgia rheumatica: a case-control study

J Rheumatol

Inflammatory changes of hip synovial structures in polymyalgia rheumatica

Clin Exp Rheumatol

Cervical interspinous bursitis in active polymyalgia rheumatica

Ann Rheum Dis

Lumbar interspinous bursitis in active polymyalgia rheumatica

Clin Exp Rheumatol

The clinical implication of cervical interspinous bursitis in the diagnosis of polymyalgia rheumatica

Ann Rheum Dis

Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica

Arthritis Rheum

Giant cell arteritis and polymyalgia rheumatica: an update

Curr Rheumatol Rep

Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis

Arthritis Rheum

Seminar
Polymyalgia rheumatica