Polymyalgia rheumatica

Polymyalgia rheumatica (gr. / Lat. Rheumatoid frequent muscle pain, polymyalgia sl ) is one among the vasculitis (blood vessel inflammation ) associated disease with acute pain of the shoulder and pelvic girdle muscles. It affects mainly older people. The cause of the disease is unknown, probably it is an autoimmune disease. The inflammation runs in polymyalgia as giant cell arteritis in the aortic arch or the proximal extremities arteries ( body trunk segments close to the arm and leg arteries ) from. In 40-50 % of cases, polymyalgia occurs along with a giant cell arteritis.

Epidemiology

Polymyalgia rheumatica is a typical disease of the elderly, usually it occurs in people over 60 years of age. Women are affected slightly more often. In about half the cases it is associated with giant cell arteritis.

Symptoms and diagnosis

Cardinal symptom of acute onset, substantial morning muscle pain in the shoulder and / or pelvic girdle area. This pain is usually bilaterally symmetrical. It occurs to some extent painful stiffness of the muscles, which can lead to paralysis. Mostly, there is also a general feeling of illness, like the flu.

Para Clinically strong signs of inflammation (increased acute-phase proteins, increased erythrocyte sedimentation rate ) and sometimes anemia can be detected. Rheumatoid factors are always negative. The electromyography is unremarkable. Leading the way is the biopsy of the temporal artery, the intima can prove the giant with the finding of a distinct loose fibrosis of the tunica. A normal finding includes a polymyalgia rheumatica but not enough. Muscle biopsy can be excluded in the presence of diagnostic uncertainty polymyositis, dermatomyositis or an inclusion body myositis.

Diagnostic criteria

4 of 7 criteria must be met ( according to Bird et al, 1979. )

  • Bilateral shoulder pain and / or stiffness (or pain in the area: neck, upper arms, buttocks, thighs )
  • Acute onset (within 2 weeks)
  • Age > 65 years (in exceptional cases even earlier )
  • Initial erythrocyte sedimentation rate of> 40 mm/1.h
  • Morning stiffness > 1 hour
  • Depression and / or weight loss
  • Bilateral upper arm pain on pressure

A key diagnostic sign is that in treating almost abruptly, so usually disappear with a higher dose of cortisone the discomfort the next day.

Therapy

On administration of glucocorticoids (100 mg / day) after a few days it comes to improvement of symptoms. If not at the same time there is an infestation of the temporal artery, can (30 mg / day ) are treated with lower initial doses. The dose is lowered only when symptoms. To prevent recurrences, maintenance therapy over a period of at least one year is required. Reduction of the dose to 2.5 mg / day is sometimes possible to the lowest possible maintenance dose. The duration of treatment is 18-24 months.

If the sole treatment does not bring satisfactory results with corticosteroids, methotrexate may also be given. But again, justifies the study location is no standard treatment, as azathioprine is not secure.

Therapy target

  • Freedom from symptoms
  • Reduction <20 mm N.W. (1- hour value )
  • CRP < 1 mg / dl
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