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Poly Rheumatica Myalgia Research Paper

Author

Ehab R Saad, MD, MA, FACP, FASN Associate Professor, Department of Medicine, Medical College of Wisconsin

Ehab R Saad, MD, MA, FACP, FASN is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Society of Nephrology, American Society of Transplantation, International Society for Peritoneal Dialysis, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Patricia J Papadopoulos, MD Staff Rheumatologist, MultiCare Rheumatology Specialists

Patricia J Papadopoulos, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American College of Rheumatology

Disclosure: Nothing to disclose.

Gloria Fioravanti, DO Clinical Assistant Professor, Program Director, Department of Internal Medicine, St Luke's Hospital of Bethlehem, Temple University School of Medicine

Gloria Fioravanti, DO is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Osteopathic Association

Disclosure: Nothing to disclose.

Allen Samuels, MD 

Allen Samuels, MD is a member of the following medical societies: American College of Rheumatology

Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD Visiting Professor of Medicine, Division of Rheumatology, State University of New York Downstate Medical Center; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital

Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Acknowledgements

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. Additionally, this publication does not imply the Federal or Department of Defense endorsement of any product.

Past Contributors

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Gino A Farina, MD, FACEP, FAAEM Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center

Gino A Farina, MD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Elliot Goldberg, MD Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine

Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology

Disclosure: Nothing to disclose.

Kristine M Lohr, MD, MS Professor, Department of Internal Medicine, Center for the Advancement of Women's Health and Division of Rheumatology, Director, Rheumatology Training Program, University of Kentucky College of Medicine

Kristine M Lohr, MD, MS is a member of the following medical societies: American College of Physicians and American College of Rheumatology

Disclosure: Nothing to disclose.

Geofrey Nochimson, MD Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital

Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

  1. Sarah L Mackie, clinical lecturer1,
  2. Christian D Mallen, professor2
  1. 1National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK
  2. 2Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  1. Correspondence to: S L Mackie s.l.mackie{at}leeds.ac.uk

Polymyalgia rheumatica causes pain and stiffness that is worst in the morning and particularly affects the shoulders and hips. It is a treatable cause of profound debility and functional impairment.1 The condition usually presents to primary care and is the most common inflammatory musculoskeletal disease in older people, with an age adjusted incidence of about one in 1000 person years.2 The lifetime risk has been estimated at 2.4% for women and 1.7% for men.3 There is little trial based evidence to guide diagnosis and treatment. This review describes current ideas about best practice in the diagnosis and management of this disease, drawing on recent clinical guidelines4 and highlighting some research priorities.

What is polymyalgia rheumatica?

The site of pathology is unclear and little is known about the causes and pathogenesis of this disease. The clinical diagnosis can be challenging owing to the lack of a specific diagnostic test. Various diagnostic and classification criteria have been proposed.56789 Classification criteria have recently been developed by the European League against Rheumatic Diseases and the American College of Rheumatology on the basis of a large prospective, international multicentre study and data driven consensus process. These are currently awaiting validation in an independent dataset (table 1⇓ …

Summary points

  • Polymyalgic syndrome can be a presenting feature of a wide range of diseases, including giant cell arteritis and rheumatoid arthritis

  • Look for other diseases before starting glucocorticoids (≤20 mg prednisolone or equivalent)

  • Carefully document the speed, completeness, and nature of the response to initial glucocorticoid treatment

  • Atypical features should prompt early specialist evaluation

  • Monitor patients carefully for adverse effects of glucocorticoids and taper drugs on an individual basis

Sources and selection criteria

We searched Medline, Embase, Cochrane Collaboration, and ClinicalTrials.gov using the word “polymyalgia”. All study types were included owing to the limited amount of literature available.

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