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Polymyalgia Rheumatica

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Part of the Perspectives in Nursing Management and Care for Older Adults book series (PNMCOA)

Abstract

Older people presenting with sudden onset shoulder or hip girdle, aches and stiffness may have polymyalgia rheumatica (PMR), one of the most common inflammatory conditions affecting people over the age of 70. While sometimes self-limiting and often successfully managed with oral glucocorticoid therapy, PMR is associated with giant cell arteritis (GCA), which can lead to permanent blindness. This chapter examines a typical PMR patient presentation, discusses differential diagnoses and identifies what nurses should include in their assessment, education and management of patients with PMR and observance for GCA.

Keywords

  • Polymyalgia rheumatica (PMR)
  • Assessment
  • Management
  • Patient education
  • Giant cell arteritis (GCA)

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References

  • Alvarez-Rodríguez L, Lopez-Hoyos M, Mata C, Marin MJ, Calvo-Alen J, Blanco R, et al. Circulating cytokines in active polymyalgia rheumatica. Ann Rheum Dis. 2010;69(1):263–9.

    PubMed  CrossRef  CAS  Google Scholar 

  • Barber HS. Myalgic syndrome with constitutional effects; polymyalgia rheumatica. Ann Rheum Dis. 1957;16(2):230–7.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  • Brassell MP. Teaching patients to cope with polymyalgia rheumatica. Nursing. 1978;8(5):22–4.

    CAS  PubMed  CrossRef  Google Scholar 

  • Brown S, Bond D, Waldron N. Less common rheumatological diseases: an introduction. Pract Nurse. 2014;44(9):40–6.

    Google Scholar 

  • Bruce W. Senile rheumatic gout. Br Med J. 1888;2(1450):811–3.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  • Crowson CS, Matteson EL. Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. Semin Arthritis Rheum. 2017;47:253–6.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum. 2011;63(3):633–9.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Dasgupta B. Polymyalgia rheumatica. In: Watts RA, Conaghan PG, Denton C, Foster H, Isaacs J, Muller-Ladner U, editors. Oxford textbook of rheumatology. 4th ed. Oxford, UK: Oxford University Press; 2013. p. 1125–31.

    Google Scholar 

  • Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology. 2010;49(1):186–90, 5p.

    PubMed  CrossRef  Google Scholar 

  • Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012a;71(4):484–92.

    PubMed  CrossRef  Google Scholar 

  • Dasgupta B, Cimmino MA, Kremers HM, Schmidt WA, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012b;64(4):943–54.

    PubMed  CrossRef  Google Scholar 

  • De Bandt M. Current diagnosis and treatment of polymyalgia rheumatica. Joint Bone Spine. 2014;81(3):203–8, 6p.

    PubMed  CrossRef  Google Scholar 

  • Dejaco C, Duftner C, Cimmino MA, Dasgupta B, Salvarani C, Crowson CS, et al. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis. 2011;70(3):447–53.

    PubMed  CrossRef  Google Scholar 

  • Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015;74(10):1799–807.

    CAS  PubMed  CrossRef  Google Scholar 

  • Dixon WG, Bansback N. Understanding the side effects of glucocorticoid therapy: shining a light on a drug everyone thinks they know. Ann Rheum Dis. 2012;71(11):1761–4.

    CAS  PubMed  CrossRef  Google Scholar 

  • Duarte C, Ferreira RJO, Mackie SL, Kirwan JR, Pereira dS. Outcome measures in polymyalgia rheumatica. A systematic review. J Rheumatol. 2015;42(12):2503–11.

    CAS  PubMed  CrossRef  Google Scholar 

  • Falsetti P, Acciai C, Volpe A, Lenzi L. Ultrasonography in early assessment of elderly patients with polymyalgic symptoms: a role in predicting diagnostic outcome? Scand J Rheumatol. 2011;40(1):57–63.

    CAS  PubMed  CrossRef  Google Scholar 

  • Fardet L. Glucocorticoid-induced adverse events in patients with giant cell arteritis or polymyalgia rheumatica. Rev Med Interne. 2013;34(7):438–43.

    CAS  PubMed  CrossRef  Google Scholar 

  • Fardet L, Fève B. Systemic glucocorticoid therapy: a review of its metabolic and cardiovascular adverse events. Drugs. 2014;74(15):1731–45, 15p.

    CAS  PubMed  CrossRef  Google Scholar 

  • Frediani B, Falsetti P, Storri L, Bisogno S, Baldi F, Campanella V, et al. Evidence for synovitis in active polymyalgia rheumatica: sonographic study in a large series of patients. J Rheumatol. 2002;29(1):123–30.

    PubMed  Google Scholar 

  • Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137–45.

    CAS  PubMed  CrossRef  Google Scholar 

  • Gonzalez-Gay M, Vazquez-Rodriguez T, Lopez-Diaz M, Miranda-Filloy J, Gonzalez-Juanatey C, Martin J, et al. Epidemiology of giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 2009;61(10):1454–61.

    PubMed  CrossRef  Google Scholar 

  • Gran JT, Myklebust G. The incidence of polymyalgia rheumatica and temporal arteritis in the county of Aust Agder, south Norway: a prospective study 1987–94. J Rheumatol. 1997;24(9):1739–43.

    CAS  PubMed  Google Scholar 

  • Green DJ, Muller S, Mallen CD, Hider SL. Fatigue as a precursor to polymyalgia rheumatica: an explorative retrospective cohort study. Scand J Rheumatol. 2015;44(3):219–23, 5p.

    CAS  PubMed  CrossRef  Google Scholar 

  • Hayward RA, Rathod T, Muller S, Hider SL, Roddy E, Mallen CD. Association of polymyalgia rheumatica with socioeconomic status in primary care: a cross-sectional observational study. Arthritis Care Res (Hoboken). 2014;66(6):956–60.

    CrossRef  Google Scholar 

  • Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. Br J Gen Pract. 2013;63(610):e361–6.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Helliwell T, Brouwer E, Pease CT, Hughes R, Hill CL, Neill LM, et al. Development of a provisional core domain set for polymyalgia rheumatica: report from the OMERACT 12 Polymyalgia Rheumatica Working Group. J Rheumatol. 2016;43(1):182–6.

    PubMed  CrossRef  Google Scholar 

  • Hennell SL. Nurse prescribing in rheumatology: a case study. Musculoskeletal Care. 2004;2(1):65–71.

    PubMed  CrossRef  Google Scholar 

  • Hennell S, Busteed S, George E. Evidence-based management for polymyalgia rheumatica for rheumatology practitioners, nurses and physiotherapists. Musculoskeletal Care. 2007;5(2):65–71.

    PubMed  CrossRef  Google Scholar 

  • Kennedy-Malone L, Enevold GL. Assessment and management of polymyalgia rheumatica in older adults. Geriatr Nurs. 2001;22(3):152–5.

    CAS  PubMed  CrossRef  Google Scholar 

  • Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013;381(9860):63–72. North American Edition, 10p.

    PubMed  CrossRef  Google Scholar 

  • Kreiner F, Langberg H, Galbo H. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica. Arthritis Rheum. 2010;62(12):3768–75.

    PubMed  CrossRef  Google Scholar 

  • Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Relapse in a population based cohort of patients with polymyalgia rheumatica. J Rheumatol. 2005a;32(1):65–73.

    PubMed  Google Scholar 

  • Kremers HM, Reinalda MS, Crowson CS, Zinsmeister AR, Hunder GG, Gabriel SE. Use of physician services in a population-based cohort of patients with polymyalgia rheumatica over the course of their disease. Arthritis Rheum. 2005b;53(3):395–403.

    PubMed  CrossRef  Google Scholar 

  • Leslie M, Fitzgerald DC, Mikanowicz C. Musculoskeletal aching in the older adult: polymyalgia rheumatica and giant cell arteritis. Top Adv Pract Nurs. 2003;3(1):5p.

    Google Scholar 

  • Macchioni P, Boiardi L, Catanoso M, Pazzola G, Salvarani C. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study. Ann Rheum Dis. 2014;73(6):1190–3.

    PubMed  CrossRef  Google Scholar 

  • Mackie SL, Mallen CD. Polymyalgia rheumatica. BMJ. 2013;347:f6937.

    PubMed  CrossRef  Google Scholar 

  • Mackie SL, Pease CT. Diagnosis and management of giant cell arteritis and polymyalgia rheumatica: challenges, controversies and practical tips. Postgrad Med J. 2013;89(1051):284–92.

    PubMed  CrossRef  Google Scholar 

  • Mackie SL, Arat S, da Silva J, Duarte C, Halliday S, Hughes R, et al. Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR. J Rheumatol. 2014;41(4):819–23.

    PubMed  CrossRef  Google Scholar 

  • Muller S, Hider SL, Belcher J, Helliwell T, Mallen CD. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Practice Research Database. Ann Rheum Dis. 2014;73(10):1769–73.

    PubMed  CrossRef  Google Scholar 

  • Muller S, Hider SL, Helliwell T, Lawton S, Barraclough K, Dasgupta B, et al. Characterising those with incident polymyalgia rheumatica in primary care: results from the PMR Cohort Study. Arthritis Res Ther. 2016;18:200.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  • Muller S, O’Brien A, Helliwell T, Hay CA, Gilbert K, Mallen CD, et al. Support available for and perceived priorities of people with polymyalgia rheumatica and giant cell arteritis: results of the PMRGCAuk members’ survey 2017. Clin Rheumatol. 2018;37(12):3411–8.

    PubMed  CrossRef  Google Scholar 

  • Owen CE, Buchanan RRC, Hoi A. Recent advances in polymyalgia rheumatica. Intern Med J. 2015;45(11):1102–8.

    CAS  PubMed  CrossRef  Google Scholar 

  • Partington R, Helliwell T, Muller S, Abdul Sultan A, Mallen C. Comorbidities in polymyalgia rheumatica: a systematic review. Arthritis Res Ther. 2018a;20(1):258.

    PubMed  PubMed Central  CrossRef  Google Scholar 

  • Partington RJ, Muller S, Helliwell T, Mallen CD, Sultan AA, Abdul Sultan A. Incidence, prevalence and treatment burden of polymyalgia rheumatica in the UK over two decades: a population-based study. Ann Rheum Dis. 2018b;77(12):1750–6.

    PubMed  CrossRef  Google Scholar 

  • Paskins Z, Whittle R, Sultan AA, Muller S, Blagojevic-Bucknall M, Helliwell T, et al. Risk of fracture among patients with polymyalgia rheumatica and giant cell arteritis: a population-based study. BMC Med. 2018;16(1):4.

    PubMed  PubMed Central  CrossRef  CAS  Google Scholar 

  • Petri H, Nevitt A, Sarsour K, Napalkov P, Collinson N. Incidence of giant cell arteritis and characteristics of patients: data-driven analysis of comorbidities. Arthritis Care Res (Hoboken). 2015;67(3):390–5.

    CAS  CrossRef  Google Scholar 

  • Raheel S, Shbeeb I, Crowson CS, Matteson EL. Epidemiology of polymyalgia rheumatica 2000–2014 and examination of incidence and survival trends over 45 years: a population-based study. Arthritis Care Res (Hoboken). 2017;69(8):1282–5.

    CrossRef  Google Scholar 

  • Ruta S, Rosa J, Navarta DA, Saucedo C, Catoggio LJ, Monaco RG, et al. Ultrasound assessment of new onset bilateral painful shoulder in patients with polymyalgia rheumatica and rheumatoid arthritis. Clin Rheumatol. 2012;31(9):1383–7.

    PubMed  CrossRef  Google Scholar 

  • Sakellariou G, Iagnocco A, Riente L, Ceccarelli F, Carli L, Di Geso L, et al. Ultrasound imaging for the rheumatologist XLIII. Ultrasonographic evaluation of shoulders and hips in patients with polymyalgia rheumatica: a systematic literature review. Clin Exp Rheumatol. 2013;31(1):1–7.

    PubMed  Google Scholar 

  • Salvarani C, Macchioni PL, Tartoni PL, Rossi F, Baricchi R, Castri C, et al. Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy. Clin Exp Rheumatol. 1987;5(3):205–15.

    CAS  PubMed  Google Scholar 

  • Salvarani C, Gabriel SE, O’Fallon WM, Hunder GG. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970–1991. Arthritis Rheum. 1995;38(3):369–73.

    CAS  PubMed  CrossRef  Google Scholar 

  • Salvarani C, Cantini F, Niccoli L, Macchioni P, Consonni D, Bajocchi G, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective follow up study. Arthritis Rheum. 2005;53(1):33–8.

    PubMed  CrossRef  Google Scholar 

  • Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372(9634):234–45.

    PubMed  CrossRef  Google Scholar 

  • Salvarani C, Barozzi L, Boiardi L, Pipitone N, Bajocchi GL, Macchioni PL, et al. Lumbar interspinous bursitis in active polymyalgia rheumatica. Clin Exp Rheumatol. 2013;31(4):526–31.

    PubMed  Google Scholar 

  • Seitz M. Polymyalgia rheumatica: what is the current status? Z Rheumatol. 2015;74(6):507–10.

    CAS  PubMed  CrossRef  Google Scholar 

  • Shbeeb I, Challah D, Raheel S, Crowson CS, Matteson EL. Comparable rates of glucocorticoid associated adverse events in patients with polymyalgia rheumatica and comorbidities in the general population. Arthritis Care Res (Hoboken). 2018;70(4):643–7.

    CAS  CrossRef  Google Scholar 

  • Smeeth L, Cook C, Hall AJ. Incidence of diagnosed polymyalgia rheumatica and temporal arteritis in the United Kingdom, 1990–2001. Ann Rheum Dis. 2006;65(8):1093–8.

    CAS  PubMed  PubMed Central  CrossRef  Google Scholar 

  • Straub RH, Cutolo M. Further evidence for insufficient hypothalamic-pituitary-glandular axes in polymyalgia rheumatica. J Rheumatol. 2006;33(7):1219–23.

    PubMed  Google Scholar 

  • Twohig H, Mitchell C, Mallen C, Adebajo A, Mathers N. ‘I suddenly felt I’d aged’: a qualitative study of patient experiences of polymyalgia rheumatica (PMR). Patient Educ Couns. 2015;98(5):645–50.

    PubMed  CrossRef  Google Scholar 

  • Van Staa TP, Laan RF, Barton IP, Cohen S, Reid DM, Cooper C. Bone density threshold and other predictors of vertebral fracture in patients receiving oral glucocorticoid therapy. Arthritis Rheum. 2003;48(11):3224–9.

    PubMed  CrossRef  CAS  Google Scholar 

  • Vivekanantham A, Blagojevic-Bucknall M, Clarkson K, Belcher J, Mallen CD, Hider SL. How common is depression in patients with polymyalgia rheumatica? Clin Rheumatol. 2018;37(6):1633–8.

    PubMed  CrossRef  Google Scholar 

  • Whitlock M, Hollywood J. Treatment guidelines for polymyalgia rheumatica: the nursing perspective. Rheumatology. 2014;53:i10.

    CrossRef  Google Scholar 

  • Yates M, Graham K, Watts RA, MacGregor AJ. The prevalence of giant cell arteritis and polymyalgia rheumatica in a UK primary care population. BMC Musculoskelet Disord. 2016;17:285.

    PubMed  PubMed Central  CrossRef  Google Scholar 

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O’Brien, A. (2020). Polymyalgia Rheumatica. In: Ryan, S. (eds) Nursing Older People with Arthritis and other Rheumatological Conditions . Perspectives in Nursing Management and Care for Older Adults. Springer, Cham. https://doi.org/10.1007/978-3-030-18012-6_4

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  • DOI: https://doi.org/10.1007/978-3-030-18012-6_4

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