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Polymyalgia rheumatica 

Polymyalgia rheumatica
Chapter:
Polymyalgia rheumatica
Author(s):

Bhaskar Dasgupta

, and Eric L. Matteson

DOI:
10.1093/med/9780198746690.003.0463
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date: 05 March 2021

Polymyalgia rheumatica is one of the common inflammatory rheumatic diseases of older people. It overlaps with inflammatory arthritis and large-vessel vasculitis, particularly giant cell arteritis. Pathogenesis is unclear and may involve recognition of an infectious agent by aberrantly activated dendritic cells. Polymyalgia rheumatica is characterized by abrupt-onset pain and morning stiffness of the shoulder and pelvic girdle muscles, with an acute phase response (elevated erythrocyte sedimentation rate and/or C-reactive protein). Evaluation can be challenging, as many clinical and laboratory features may also be present in other conditions, including other rheumatological diseases, infection, and neoplasia. The mainstay of therapy is glucocorticoids. Adjunctive therapy can be initiated early in the disease course in patients with high risk of glucocorticoid-related side effects, severe or relapsing disease, or poor or ill sustained response to glucocorticoids. The response to standardized therapy is heterogeneous, and a significant proportion of patients do not respond completely.

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