Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment

Arthur E Brawer Division of Rheumatology, Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA Objectives: The diagnostic diversity of polymyalgia rheumatica (PMR) can easily be obscured by the widespread use of corticosteroids (CSs) early in the disease course. This study observed...

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Autor principal:	Brawer AE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Polymyalgia Rheumatica Rheumatoid Arthritis Corticosteroids Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/fac9e62500f2409f8a4bc8f1a16b277b
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spelling	oai:doaj.org-article:fac9e62500f2409f8a4bc8f1a16b277b2021-12-02T02:54:14ZPolymyalgia rheumatica: observations of disease evolution without corticosteroid treatment1179-156Xhttps://doaj.org/article/fac9e62500f2409f8a4bc8f1a16b277b2016-04-01T00:00:00Zhttps://www.dovepress.com/polymyalgia-rheumatica-observations-of-disease-evolution-without-corti-peer-reviewed-article-OARRRhttps://doaj.org/toc/1179-156XArthur E Brawer Division of Rheumatology, Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA Objectives: The diagnostic diversity of polymyalgia rheumatica (PMR) can easily be obscured by the widespread use of corticosteroids (CSs) early in the disease course. This study observed the course of PMR without CSs and determined whether alternative medication could be useful. Methods: Seventy patients with new-onset PMR comprised phase 1. Eight were removed with specific diagnoses (four with giant cell arteritis [GCA]). The remaining 62 were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone until enough time had elapsed to ascertain whether their PMR had evolved into another rheumatologic inflammatory condition. Hydroxychloroquine (HCQ) was then added to their regimen. Twenty-five additional patients with PMR comprised phase 2. Twenty-two were immediately treated with HCQ prior to the anticipated disease progression. Results: In phase 1, 52/62 developed synovitis in multiple other joints 9 months from PMR onset; 48/52 received HCQ, and 42/48 (87.5%) achieved complete remission. In phase 2, during HCQ induction, 21 patients developed similar synovitis; after 6 months of HCQ use, 80% achieved remission. In 73/95 (77%), a definite diagnosis of rheumatoid arthritis (RA) could be made on average 8.5 months from PMR onset. Only 12/95 (13%) stayed true to form with their PMR and did not develop another specific diagnosis. Conclusion: In this study, true PMR was infrequent in the absence of GCA. PMR in most patients evolved into seronegative RA, which was dramatically responsive to HCQ use. Treatment of acute PMR with HCQ was a rational alternative to CS use even if progressive additive synovitis had not yet occurred. Keywords: polymyalgia rheumatica, rheumatoid arthritis, corticosteroidsBrawer AEDove Medical PressarticlePolymyalgia RheumaticaRheumatoid ArthritisCorticosteroidsDiseases of the musculoskeletal systemRC925-935ENOpen Access Rheumatology: Research and Reviews, Vol 2016, Iss Issue 1, Pp 45-49 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Polymyalgia Rheumatica Rheumatoid Arthritis Corticosteroids Diseases of the musculoskeletal system RC925-935
spellingShingle	Polymyalgia Rheumatica Rheumatoid Arthritis Corticosteroids Diseases of the musculoskeletal system RC925-935 Brawer AE Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
description	Arthur E Brawer Division of Rheumatology, Department of Medicine, Monmouth Medical Center, Long Branch, NJ, USA Objectives: The diagnostic diversity of polymyalgia rheumatica (PMR) can easily be obscured by the widespread use of corticosteroids (CSs) early in the disease course. This study observed the course of PMR without CSs and determined whether alternative medication could be useful. Methods: Seventy patients with new-onset PMR comprised phase 1. Eight were removed with specific diagnoses (four with giant cell arteritis [GCA]). The remaining 62 were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone until enough time had elapsed to ascertain whether their PMR had evolved into another rheumatologic inflammatory condition. Hydroxychloroquine (HCQ) was then added to their regimen. Twenty-five additional patients with PMR comprised phase 2. Twenty-two were immediately treated with HCQ prior to the anticipated disease progression. Results: In phase 1, 52/62 developed synovitis in multiple other joints 9 months from PMR onset; 48/52 received HCQ, and 42/48 (87.5%) achieved complete remission. In phase 2, during HCQ induction, 21 patients developed similar synovitis; after 6 months of HCQ use, 80% achieved remission. In 73/95 (77%), a definite diagnosis of rheumatoid arthritis (RA) could be made on average 8.5 months from PMR onset. Only 12/95 (13%) stayed true to form with their PMR and did not develop another specific diagnosis. Conclusion: In this study, true PMR was infrequent in the absence of GCA. PMR in most patients evolved into seronegative RA, which was dramatically responsive to HCQ use. Treatment of acute PMR with HCQ was a rational alternative to CS use even if progressive additive synovitis had not yet occurred. Keywords: polymyalgia rheumatica, rheumatoid arthritis, corticosteroids
format	article
author	Brawer AE
author_facet	Brawer AE
author_sort	Brawer AE
title	Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
title_short	Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
title_full	Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
title_fullStr	Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
title_full_unstemmed	Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
title_sort	polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/fac9e62500f2409f8a4bc8f1a16b277b
work_keys_str_mv	AT brawerae polymyalgiarheumaticaobservationsofdiseaseevolutionwithoutcorticosteroidtreatment
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Polymyalgia rheumatica: observations of disease evolution without corticosteroid treatment

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