Thursday, July 18, 2024

Can Polymyalgia Be Mistaken For Rheumatoid Arthritis

Similarities To Other Diseases

Polymyalgia Rheumatica: A Rheumatologist explains

Polymyalgia Rheumatica is sometimes mistaken for another type of inflammatory arthritis called Rheumatoid Arthritis . Rheumatoid Arthritis can also start in the joints of the shoulders, causing pain and stiffness. Rheumatoid Arthritis isn’t like Polymyalgia Rheumatica because in Rheumatoid Arthritis other joints usually become affected over time. Polymyalgia rheumatica should really only affect the joints surrounding the shoulders and the hips.

A variety of other conditions can sometimes act like Polymyalgia Rheumatica, but are not related to any type of arthritis at all. These include some types of cancer, heart infections, and thyroid conditions.

Can Polymyalgia Turn Into Rheumatoid Arthritis

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Polymyalgia rheumatica can not be cured but there is. system which causes it to turn upon. is also responsible for rheumatoid arthritis and.

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

In the rodent study, those fed one gram of dry onion daily experienced a 20 percent reduction in the bone breakdown process that can lead to osteoporosis. “Adding.

Who Gets Polymyalgia Rheumatica

People who develop Polymyalgia Rheumatica are older than 50. Women are more likely to get Polymyalgia Rheumatica than men.

Polymyalgia Rheumatica can also occur with another condition called Giant Cell Arteritis, which is commonly known as temporal arteritis. About 15 out of every 100 people with Polymyalgia Rheumatica also have temporal arteritis.

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How Else Can Your Gp Surgery Help

Your GP surgery can be involved in your RA care in many different ways. They continue to look after you in general and may want to keep a close eye on your blood pressure, cholesterol and blood glucose levels as there is a higher risk of heart disease in people affected by rheumatoid arthritis. This is often done as an annual review with one of the practice nurses. Many GP surgeries are involved in doing the blood monitoring for the specific drugs used in controlling and treating the joint inflammation , so you may get your regular blood tests performed by your surgery.

Rheumatoid arthritis, along with many of the treatments used affects the bodys immune response to infections. Your surgery may therefore contact you to offer you annual influenza jab and also a Pneumovax for pneumonia . With some of these treatments live vaccines should be avoided so please ensure you contact your Doctors surgery if you are planning to travel abroad.

How Polymyalgia Rheumatica Is Treated

Almost all patients with polymyalgia rheumatica are treated with prednisone, a type of steroid that eases inflammation in the body the American College of Rheumatology recommends starting with 12.5 to 25 milligrams of prednisone daily. Patients with PMR respond extremely well to those low doses of steroids, says Dr. Loupasakis. Within the first three days they will notice improvement right away usually within 24 hours. Those with accompanying GCA generally need higher doses of steroids for the medication to take effect, he adds.

The treatment wont work unless patients stick with it, but corticosteroids can have serious long-term side effects such as kidney problems, vision changes, and increased blood pressure. Thats why doctors have PMR patients dial down their dosage to about 10 milligrams within the first two to three months, then drop down another milligram every month unless theres a flare, says Dr. Davis. We try to taper the dose and keep it as low as tolerated, he says.

Meanwhile, patients might also start regimens like taking calcium and vitamin D supplements to prevent bone loss and other side effects of steroids. Most people with PMR can finish up steroids and be symptom-free after a year or two, but some might need to stay on medication for up to five years.

If you have PMR and suspect you could also have giant cell arteritis , see a doctor right away. GCA can affect blood flow to the eyes and can cause permanent vision loss if left untreated.

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What Is The Long

With careful monitoring and appropriate treatment, most patients with polymyalgia rheumatica or temporal arteritis have a normal life span and lifestyle. Most of the time, these diseases can be successfully controlled with steroids and other drugs .

The success of treatment is related to prompt diagnosis, aggressive treatment, and careful follow-up to prevent or minimize side effects from the medications.

Making A Diagnosis Of Rheumatoid Arthritis

Diagnosis of RA is not straight forward as there is no individual test for RA. A diagnosis tends to be made by a consultant rheumatologist on the basis of tests, examination and ruling out other possible causes for symptoms.

Sometimes it is clear from symptoms and initial blood tests that someone has rheumatoid arthritis, but not always. Specialist criteria have been developed jointly by American and European experts to try to help make a diagnosis of rheumatoid arthritis in people presenting with new-onset swollen, painful joints with no obvious cause . These should be used with care though as people with osteoarthritis or a crystal arthritis could meet the criteria and end up being incorrectly diagnosed with rheumatoid arthritis, which could have significant consequences for treatment. They have also been developed to classify, not diagnose, rheumatoid arthritis and so should not be used to decide who gets referred.

As already mentioned above, there are a number of other conditions that can cause very similar symptoms to rheumatoid arthritis and your GP will have to consider these when assessing each case.

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Common Causes And Risk Factors Of Polymyalgia Rheumatica

Polymyalgia rheumatica is a condition that causes significant pain and stiffness in huge muscle groups across the body. PMR’s etiology is unknown. However, scientific data suggest that it may occur as a result of the interaction of various elements.

  • Genetic predisposition: There is evidence to suggest that hereditary factors may increase vulnerability to PMR.
  • Viral Infections:
  • PMR has been linked to seasonal viral infections. The abrupt development of symptoms with occasional abatement seen in patients with PMR can be explained by viruses‘ cyclic replication patterns.
  • Importantly, viruses, such as adenovirus, human parainfluenza virus, and parvovirus B19, have been linked to PMR.
  • Only adults aged older than 60 years are affected.
  • The cause is sometimes linked to the aging process.
  • More frequently seen in Caucasians though all ethnicities can be affected.
  • People of Northern European and Scandinavian descent have the highest risk of getting the disease.
  • Gender: Common in both males and females but more frequently seen in women.
  • Rarely, the disease occurs in an individual who has cancer.
  • Another hypothesized cause of PMR is overexposure to ultraviolet radiation from the sun, which damages the superficial arteries.
  • According to certain research, ultraviolet rays harm the elastic fibers found in arteries and synovial membranes. These injured tissues may become infected by viruses that lay dormant for a long period and then reactivate, resulting in PMR.
  • What Should Be Done If Rheumatoid Arthritis Is Suspected

    All you need to know about polymyalgia rheumatica – Online interview

    Any person who is suspected of having RA should be referred to a specialist rheumatologist. Early referral is important so that disease modifying anti-rheumatic drugs may be prescribed as soon as possible so as to slow or halt the disease process. Delay in referral or receiving a definitive diagnosis and treatment can result in significant costs to the individual, particularly those who are employed. This is because joint damage occurs most rapidly in the early stages of the disease, and often the treatment drugs can take several months to work.

    Investigations can be normal in rheumatoid arthritis, particularly early in the disease, and therefore there is no need to wait for results before the referral. In cases where it is felt that the most likely diagnosis is one of the conditions mentioned above then it is probable that you would be reviewed with the results of your investigations as these do not require an urgent referral. The Scottish equivalent of NICE also advises early referral. Both guidelines emphasise the importance of the history of what has been happening. As there is a strong genetic element to rheumatoid arthritis, it is very helpful to let your GP know if other members of your family are also affected by RA or another auto-immune condition.

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    Data Sources Searches And Study Selection

    The search was conducted in MEDLINE, EMBASE, PsyciINFO and CINAHL from their inception until the date of search in November 2016. Additional articles were found by examining reference lists of included studies and an updated search was run in June 2018 which led to the inclusion of a further study. The exploded MeSH terms polymyalgia rheumatica and giant cell arteritis were used in combination with text word searches for the same as well as for PMR and Giant Cell Arteritis . GCA is a vasculitis which very commonly co-occurs with PMR around 1030% of patients with PMR develop GCA during the course of their illness . Given this overlap in conditions, GCA was included to increase the likelihood of ensuring that all studies in which PMR comorbidities were considered were included in the review. PRISMA guidelines were followed throughout the review process .

    All article titles identified were screened by a single reviewer against the inclusion and exclusion criteria. A random sample of 100 of these titles was reviewed by a second reviewer and agreement between decisions was assessed using adjusted calculation . All selected abstracts were then assessed by two reviewers . Any citation thought to be eligible by either reviewer was carried forward to full text review. Reasons for exclusion were recorded. Finally, the remaining full texts were reviewed by the same two authors and a list of papers to be included in the narrative synthesis was created.

    Symptoms Of Polymyalgia Rheumatica

    Generally, symptoms affect both sides of the body andinclude:

    • Pain in the shoulders that can spread to theneck or arms
    • Pain in the hips that can spread to the buttocksor thighs
    • Stiffness in affected areas that is worse in themorning or after inactivity
    • Reduced range of motion in affected areas

    Other symptoms can include:

    • Feeling of illness or discomfort
    • Loss of appetite, which can lead to weight loss

    We typically monitor patients with polymyalgia rheumaticaregularly because giant cell arteritis occurs in roughly 15 percent of patientswith polymyalgia rheumatica. Giant cell arteritis is inflammation in the liningof the arteries that support the eyes, and it causes different symptoms. Rarely but devastating if untreated giant cell arteritis can result in strokeor blindness.

    The following symptoms suggest giant cell arteritis andshould prompt immediate medical attention.

    • Persistent, new, or unusual headaches
    • Jaw pain or tenderness
    • Vision loss, or blurred or double vision
    • Scalp tenderness

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    What Conditions May Be Confused With Ra


    People with this condition often feel pain all over, in all their muscles and joints, and have multiple tender points when examined. They will also often have a degree of early morning stiffness. Poor unrestorative sleep is often present, with associated fatigue and low mood, and often there are associated symptoms of headaches and irritable bowels and bladder. Investigations tend to be normal. It is important to distinguish this condition from rheumatoid arthritis as their management is very different, although sometimes both conditions are present.

    Polymyalgia Rheumatica

    This condition causes pain and stiffness of the shoulders and thighs and tends to occur in people over 65 years of age. It is more common in females. Sometimes elderly people with RA present with similar symptoms. PMR is treated by a course of steroid tablets where the dosage is gradually reduced over months and can generally be stopped after about 18 months 2 years. In people with RA presenting with PMR type symptoms, the correct diagnosis of RA usually becomes apparent when the patient is unable to reduce the steroid dosage below 10mg.

    Post-viral arthritis


    Crystal Arthritis

    Other types of inflammatory arthritis

    Diagnostic And Classification Criteria

    The diagnosis of PMR is challenging, due to lack of any specific diagnostic test and the presence of other conditions mimicking PMR, mainly elderly onset seronegative RA.20-22 Due to uncertainty related to the diagnosis of PMR, a prompt response to glucocorticoid treatment has been commonly used to establish the diagnosis. However, only about half of patients respond completely to GC after 3 weeks of treatment with 15 mg oral prednisolone.23 Additionally, response to GC can be observed in other mimics of PMR.24

    To date, several diagnostic and classification criteria sets for PMR have been defined in the literature they have some features in common, such as an age cut off, elevated markers of inflammation, and pain and/or stiffness in the shoulder and/or hip girdles.1,25-28

    The 1987 ACR32 and, more recently, the 2010 ACR/EULAR33 classification criteria for RA provide criteria for the classification of patients as having RA as opposed to other joint diseases. The specificity and sensitivity of the old criteria was not adequate for the classification of patients with early inflammatory arthritis as having RA.34 To detect early RA, on the other hand, the new criteria give much weight to RA serologic biomarkers, which may result in failure to identify individuals with seronegative RA.35 Thus, the difference between proportions of patients fulfilling the new or old criteria sets highlights the importance of both criteria, especially in cases of seronegative RA.

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    Statement Of Principle Findings

    This review found some evidence of an association between PMR and vascular disease, and possibly cancer, particularly in the first 6 months following diagnosis. However, the evidence for this is not robust.

    The concentration of the apparent association between PMR and cancer in the first 6 months following diagnosis suggests the possibility of an element of misdiagnosis. This could occur as some of the features of PMR are also non-specific early features of some cancers. Furthermore, as time passed, the rate of diagnosis of cancer was found to drop down to the background population rate.

    Regarding specific types of cancer, some studies have proposed there could be associations between PMR and haematological cancers. This includes Hodgkins and non-Hodgkins lymphoma , myeloma and other myeloid malignancies . An increase in the risk of lymphoma has been observed with RA, which has been postulated to be due to higher accumulated inflammatory activity in RA a similar mechanism may lie behind the apparent increase in patients with PMR.

    These two studies employed similar approaches selecting with PMR from linked UK databases. However, a number of differences existed between the studies, including the age of participants , average years of follow up as well as the total number of patients found with PMR . Potentially, the variation in risk of vascular events between these studies could be explained by the differences in follow up or the age distribution of the study population.

    Fibromyalgia Can Be Tricky To Diagnose Which Is Why You May Have One Of These Other Conditions Instead

    While no one knows what exactly causes fibromyalgia, doctors do know a few things about the condition: The widespread chronic pain disorder seems to involve the nervous system affects 2 to 4 percent of Americans, mostly women and commonly occurs in people who have other types of musculoskeletal pain, such as different kinds of arthritis.

    But unlike many musculoskeletal conditions, fibromyalgia isnt an inflammatory or autoimmune disease when your immune system, which normally protects your body from infection, turns against itself and attacks your own cells and tissues. That can produce chronic inflammation that can eventually damage your body. Fibromyalgia is also not a joint or muscle disorder caused by physical injury.

    Instead, experts think that fibromyalgia is neurological in nature.

    Fibromyalgia is a disorder in which the sensitivity to pain has been turned up in the brain, says J. Michelle Kahlenberg, MD, PhD, an associate professor in the division of rheumatology at the University of Michigan Medical School in Ann Arbor. Chemical transmitters in the brain have gotten reprogrammed so that they are firing pain signals with very minimal stimuli. A squeeze of the arm, a shake of the hand, a touch on the shoulder all of those things can be very painful for people with fibromyalgia.

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    How Are Polymyalgia Rheumatica And Temporal Arteritis Diagnosed

    Under the new criteria developed by the American College of Rheumatology and The European League Against Rheumatism, patients ages 50 years and older can be classified as having PMR if they meet the conditions below:

    The new classification criteria may also help to evaluate existing treatments for polymyalgia rheumatica.

    Everyone with polymyalgia rheumatica is typically tested for temporal arteritis. This, too, would start with the exam and listening to the patient’s symptoms.

    If temporal arteritis is suspected, but less convincing features are present, a temporal artery biopsy may confirm the diagnosis. The biopsy is taken from a part of the artery located in the hairline, in front of the ear. In most cases the biopsy is helpful, but in some individuals it may be negative or normal, even though the person does have temporal arteritis.

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