Polymyalgia rheumatica

The autoimmune rheumatic diseases consists of Rheumatoid Arthritis (RA), Spondylarthritis (SpA), Systemic Lupus Erythematosus (SLE), Polymyositis, Dermatomyositis, Polymyalgia Rheumatica, Acute Temporal Arteritis, Giant Cell Arteritis, Behcet s Disease, Sjorgren s Syndrome, Felty s Syndrome and Mixed Connective Tissue Disease (MCTD). Spondylarthritis (SpA) can be subdivided in Reactive Arthritis (ReA), Ankylosing Spondylitis (AS), Psoriatic Arthritis (PsA), Arthritis associated with the inflammatory bowel diseases are Crohn s disease and Ulcerative Colitis (IBD), Undifferentiated SpA (UspA) and Sacro-ilitis, Juvenile SpA and Acute Anterior Uveitis (AAU). 

Idiopathic thrombocytopenic purpura Membranous glomerulonephritis Polymyalgia rheumatica Polymyositis Psoriatic arthropathies Rheumatoid arthritis Systemic lupus erythematosus Ulcerative colitis Uveitis... 

Although corticosteroids possess immunosuppressive properties, their real value is in controlling the inflammation that can accompany transplantation and autoimmune disorders. Virtually all phases of the inflammatory process are affected by these drugs. Corticosteroid therapy alone is successful in only a limited number of autoimmune diseases, such as idiopathic thrombocytopenia, hemolytic anemia, and polymyalgia rheumatica. 

Collagen-vascular disorders Giant cell arteritis, lupus erythematosus, mixed connective tissue syndromes, polymyositis, polymyalgia rheumatica, rheumatoid arthritis, temporal arteritis... 

A 68-year-old woman who had taken prednisone 30 mg/day for polymyalgia rheumatica for 6 months developed sharp stabbing abdominal pain, fever (39°C), and vomiting. Her serum amylase was 310 IU/ 1, serum lipase 340 IU/1, and urinary amylase 1560 IU/1. Other causes of pancreatitis were ruled out. She had been taking a thiazide diuretic therapy for the past 10 years. Her symptoms improved noticeably after prednisone withdrawal. 

Fatal aspergillosis with a thyroid gland abscess occurred in a 74-year-old man after treatment with prednisolone for polymyalgia rheumatica (338). 

An 84-year-old woman with polymyalgia rheumatica and a 79-year-old woman with undifferentiated connective tissue disease and leukocytoclastic vasculitis were given prednisolone 20 mg/day with subsequent dosage reductions. The first patient developed a raised purpuric rash and lymphedema of the left leg within 5 months and the second developed large purple nodules on the soles of her feet and the backs of her hands accompanied by periorbital and peripheral edema. Skin biopsies showed Kaposi s sarcoma, and both patients had raised IgG antibody titers to human herpesvirus-8. 

Krogsgaard MR, Thamsborg G, Lund B. Changes in bone mass during low dose corticosteroid treatment in patients with polymyalgia rheumatica. a double blind, prospective comparison between prednisolone and deflazacort. Ann Rheum Dis 1996 55(2) 143-6. 

Healey JH, Paget SA, Williams-Russo P, Szatrowski TP, Schneider R, Spiera H, Mitnick H, Ales K, Schwartzberg P. A randomized controlled trial of salmon calcitonin to prevent bone loss in corticosteroid-treated temporal arteritis and polymyalgia rheumatica. Calcif Tissue Int 1996 58(2) 73-80. 

Salmon calcitonin nasal spray prevented bone loss in the lumbar spine of 31 patients treated with prednisone for polymyalgia rheumatica (SEDA-22, 448) (9). They were randomized to salmon calcitonin nasal spray 200 IU/day or matched placebo for 1 year. Both groups were treated with calcium supplements if their dietary intake was below 800 mg/day. With calcitonin the mean bone mineral density in the lumbar spine fell by 1.3% and with placebo by 5% after 1 year. There were no differences in the hip, including the femoral neck and trochanter, or in total body bone density. 

B15. Bridgeford, P. H., Lowenstein, M., Bocanegra, T. S., Vasey, F. B., Germain, B. F., and Espinoza, L. R., Polymyalgia rheumatica and giant cell arteritis Histocompatibility typing and hepatitis-B infection studies. Arthritis Rheum. 23, 516-518 (1980). 

E3. Elling, H., Skinhoj, P., and Elling, P., Hepatitis B virus and polymyalgia rheumatica a search for HBsAg, HBsAb, HBeAg and HBeAb. Ann. Rheum. Dis. 39, 511-513 (1980). 

PI. Papaionnou, C. C., Gupta, R. C., Hunder, G. G., and McDuffie, F. C., Circulating immune complexes in giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum. 23, 1021-1025 (1980). 

Askling J, Klareskog L, Hjalgrim H, Baecklund E, Bjorkholm M, Ekbom A. Do steroids increase lymphoma risk A case-control study of lymphoma risk in polymyalgia rheumatica/giant cell arteritis. Ann Rheumat Dis 2005 64 1765-8. 

Collagen diseases, if severe, e.g. lupus erythematosus (systemic), polyarteritis nodosa, polymyalgia rheumatica and cranial giant cell arteritis (urgent therapy to save sight), dermatomyositis... 

Basedow hyperthyroidism BCG vaccine Erythematodes visceralis Granulomatosis infantisepticum Hypogammaglobulinaemia Polymyalgia rheumatica Primary biliary cholangitis Sarcoidosis Vasculitis... 

Kosolcharoen, R, Magnin, G.E. Liver dysfunction and polymyalgia rheumatica. A case report. X. Rheumat. 1976 3 50-53... 

Kyle, V., Wraight, E.R, Hazleman, B.L. Liver scan abnormaUties in polymyalgia rheumatica/giant-cell arteriitis. Clin. Rheumatol. 1991 10 294-297... 

Leong, A.S., Alp, M.H. Hepatocellular disease in the giant cell arteri-itis/polymyalgia rheumatica syndrome. Ann. Rheum. Dis. 1981 40 ... 

However, salmon calcitonin nasal spray prevented bone loss in the lumbar spine of 31 patients treated with prednisone for polymyalgia rheumatica (SEDA-22, 448)... 

There have been reports of individual cases of giant cell arteritis (48) and polymyalgia rheumatica (49,50) in temporal relation to influenza vaccine. 

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