Laboratory parameters of the 1st order – obligatory laboratory tests. ESR (erythrocyte sedimentation rate) [“fall”: > 40 mm in the 1st hour (> 90% of cases)] CRP (C-reactive protein) [pathologically elevated] Small blood count Creatine kinase (CK) [not elevated] Rheumatoid factors (RF) [negative] Antibodies against citrullinated peptides [negative].
Therapeutic target Pain relief Therapy recommendations After diagnosis, immediate initiation of therapy: prednisolone (glucocorticoids). If necessary, in combination with in combination with methotrexate (MTX (immunosuppressants / drugs that reduce the functions of the immune system)/ esp. in recurrent courses and in cases where it is not possible to reduce the steroid dose to or below … Polymyalgia Rheumatica: Drug Therapy
Obligatory medical device diagnostics. Arthrosonography (ultrasonography of joints) [Unlike rheumatoid arthritis, polymyalgia rheumatica does not cause structural joint changes; tendosynovialitis (inflammation of the tendon sheath), bursitis (inflammation of the bursa) subdeltoid or/and synovitis (inflammation of the synovial membrane) of the glenohumeral joints (shoulder joint) may be detectable]. Color duplex sonography of the temporal artery (temporal … Polymyalgia Rheumatica: Diagnostic Tests
The following symptoms and complaints may indicate polymyalgia rheumatica (PMR): Girdling myalgia (muscle pain), symmetrically occurring, primarily affecting: Shoulder girdle/shoulder pain (70-95%). Neck and/or pelvic girdle (50-90%), bilateral (50-70%). Pressure painfulness Stiffness of the muscles, especially long-lasting morning stiffness (> 45 min). Weakness of the musculature General symptoms (fever, anorexia (loss of appetite), weakness and/or … Polymyalgia Rheumatica: Symptoms, Complaints, Signs
Pathogenesis (disease development) The causes of polymyalgia rheumatica (PMR) and giant cell arteritis (RZA) are unknown. Infections are thought to play a role, in addition to genetic factors such as female sex and polymorphisms in the HLA class II gene. It has been shown that there is a nonspecific increase in the immune response. Etiology … Polymyalgia Rheumatica: Causes
General measures Nicotine restriction (refraining from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day). Nutritional medicine Nutritional counseling based on nutritional analysis Observance of the following nutritional medical recommendations: Avoid foods high in arachidonic acid (animal foods such as pork and pork products, tuna)! … Polymyalgia Rheumatica: Therapy
The following are the most important diseases or complications that may be contributed to by polymyalgia rheumatica (PMR): Endocrine, nutritional, and metabolic diseases (E00-E90). Diabetes mellitus type 2 due to glucocorticoid therapy. Cardiovascular system (I00-I99). Aortic aneurysm (bulging of the aorta) – occurs in 20-30% of cases during the course of the disease. Atherosclerosis (synonyms: … Polymyalgia Rheumatica: Complications
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure (bilateral blood pressure measurement), pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Gait (fluid, limping). Body or joint posture (upright, bent, gentle posture). Joints … Polymyalgia Rheumatica: Examination
Medical history (history of illness) represents an important component in the diagnosis of polymyalgia rheumatica (PMR) and giant cell arteritis (RZA). Family history Are there any diseases in your family that are common? Social anamnesis Current medical history/systemic history (somatic and psychological complaints). What symptoms have you noticed? Are you experiencing any pain? In which … Polymyalgia Rheumatica: Medical History
Cardiovascular System (I00-I99). Endocarditis (endocardial inflammation). Infectious and parasitic diseases (A00-B99). Chronic infections (e.g., tuberculosis). Musculoskeletal system and connective tissue (M00-M99). Chondrocalcinosis (synonym: pseudogout) – gout-like disease of the joints caused by deposition of calcium pyrophosphate in cartilage and other tissues; leads, among other things, to joint degeneration (often of the knee joint); symptomatology resembles … Polymyalgia Rheumatica: Or something else? Differential Diagnosis
