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.
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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.
Barber HS. Myalgic syndrome with constitutional effects; polymyalgia rheumatica. Ann Rheum Dis. 1957;16(2):230–7.
Brassell MP. Teaching patients to cope with polymyalgia rheumatica. Nursing. 1978;8(5):22–4.
Brown S, Bond D, Waldron N. Less common rheumatological diseases: an introduction. Pract Nurse. 2014;44(9):40–6.
Bruce W. Senile rheumatic gout. Br Med J. 1888;2(1450):811–3.
Crowson CS, Matteson EL. Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. Semin Arthritis Rheum. 2017;47:253–6.
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.
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.
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.
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.
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.
De Bandt M. Current diagnosis and treatment of polymyalgia rheumatica. Joint Bone Spine. 2014;81(3):203–8, 6p.
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.
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.
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.
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.
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.
Fardet L. Glucocorticoid-induced adverse events in patients with giant cell arteritis or polymyalgia rheumatica. Rev Med Interne. 2013;34(7):438–43.
Fardet L, Fève B. Systemic glucocorticoid therapy: a review of its metabolic and cardiovascular adverse events. Drugs. 2014;74(15):1731–45, 15p.
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.
Fries JF, Spitz P, Kraines RG, Holman HR. Measurement of patient outcome in arthritis. Arthritis Rheum. 1980;23(2):137–45.
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.
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.
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.
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.
Helliwell T, Hider SL, Mallen CD. Polymyalgia rheumatica: diagnosis, prescribing, and monitoring in general practice. Br J Gen Pract. 2013;63(610):e361–6.
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.
Hennell SL. Nurse prescribing in rheumatology: a case study. Musculoskeletal Care. 2004;2(1):65–71.
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.
Kennedy-Malone L, Enevold GL. Assessment and management of polymyalgia rheumatica in older adults. Geriatr Nurs. 2001;22(3):152–5.
Kermani TA, Warrington KJ. Polymyalgia rheumatica. Lancet. 2013;381(9860):63–72. North American Edition, 10p.
Kreiner F, Langberg H, Galbo H. Increased muscle interstitial levels of inflammatory cytokines in polymyalgia rheumatica. Arthritis Rheum. 2010;62(12):3768–75.
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.
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.
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.
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.
Mackie SL, Mallen CD. Polymyalgia rheumatica. BMJ. 2013;347:f6937.
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.
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.
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.
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.
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.
Owen CE, Buchanan RRC, Hoi A. Recent advances in polymyalgia rheumatica. Intern Med J. 2015;45(11):1102–8.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372(9634):234–45.
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.
Seitz M. Polymyalgia rheumatica: what is the current status? Z Rheumatol. 2015;74(6):507–10.
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.
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.
Straub RH, Cutolo M. Further evidence for insufficient hypothalamic-pituitary-glandular axes in polymyalgia rheumatica. J Rheumatol. 2006;33(7):1219–23.
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.
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.
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.
Whitlock M, Hollywood J. Treatment guidelines for polymyalgia rheumatica: the nursing perspective. Rheumatology. 2014;53:i10.
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.
Further Reading
American College of Rheumatology: PMR homepage. Available from: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Polymyalgia-Rheumatica. Accessed 02 Apr 19.
Arthritis Foundation. Available from: http://www.arthritis.org/.
Dasgupta B, Raine C. Polymyalgia rheumatica, Section 18, Chapter 134: Polymyalgia rheumatica. In: Watts RA, Conaghan PG, Denton C, Foster H, Isaacs J, Müller-Ladner U, editors. Oxford textbook of rheumatology. 4th ed. Oxford: Oxford University Press; 2018. https://doi.org/10.1093/med/9780199642489.003.0134_update_001. Accessed 02 Apr 19.
PMR and GCA patient peer support. Available from: https://healthunlocked.com/pmrgcauk. Accessed 02 Apr 19.
PMRGCAuk Patient support charity homepage. Available from: http://www.pmrgca.co.uk/content/home-page. Accessed 02 Apr 19.
Support groups for patients in Europe. Available from: https://www.eular.org/pare_member_orgs.cfm.
Versus Arthritis: Patient information about PMR. Available from: https://www.versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/?gclid=EAIaIQobChMI0OLlmK2v4QIVSZPtCh3TtgSREAAYASAAEgL_-_D_BwE. Accessed 02 Apr 19.
Versus Arthritis: Steroid tablets information booklet. Available from: https://www.versusarthritis.org/media/1362/steroid-tablets-information-booklet.pdf. Accessed 10 Apr 19.
Versus Arthritis: Steroid drug treatment information. Available from: https://www.versusarthritis.org/about-arthritis/treatments/drugs/steroids/. Accessed 10 Apr 19.
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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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