Polymyalgia rheumatica
| Classification according to ICD-10 | |
|---|---|
| M35.3 | Polymyalgia rheumatica |
| M31.5 | Giant cell arteritis in polymyalgia rheumatica |
| ICD-10 online (WHO version 2019) | |
The polymyalgia rheumatica (gr./lat. Rheumatoid frequent muscle pain , coll. Polymyalgia abbreviated PMR ) is an inflammatory disease with acute onset pain of shoulder and pelvic girdle muscles. It mostly affects the elderly. The muscle pain is similar to that of fibromyalgia syndrome . The cause of the disease is unknown; it is likely an autoimmune disease . In 40–50% of cases, polymyalgia occurs together with giant cell arteritis .
Epidemiology
Polymyalgia rheumatica is a typical disease in older people. It usually occurs in people over 60. Women are affected a little more often. In about half of the cases it is associated with giant cell arteritis .
Symptoms and diagnosis
The cardinal symptom is the acute onset of significant morning muscle pain in the shoulder and / or pelvic girdle area. This pain is usually laterally symmetrical. The muscles become stiff, sometimes painful, which can lead to the inability to move. Usually there is also a general feeling of illness, like a flu-like infection.
Paraclinically, strong signs of inflammation (increased acute phase proteins , increased sedimentation rate ) and sometimes anemia can be detected. The determination of rheumatoid factors is not helpful for the diagnosis. The electromyography is unremarkable. In the muscle biopsy , the presence of polymyositis , dermatomyositis, or inclusion body myositis can be excluded if there is diagnostic uncertainty .
Diagnostic criteria
four out of seven criteria must be met (according to Bird et al., 1979):
- shoulder pain on both sides and / or stiffness (alternatively pain in the area of: neck, upper arms, buttocks, thighs)
- acute onset of illness (within two weeks)
- Age> 65 years (in exceptional cases also earlier)
- initial erythrocyte sedimentation rate > 40 mm / 1.h
- morning stiffness> 1 hour
- Depression and / or weight loss
- bilateral upper arm tenderness
A decisive diagnostic sign is that when treated with a higher dose of cortisone, the symptoms disappear almost suddenly, usually on the next day.
therapy
With sufficient administration of glucocorticoids (30 mg / day), symptoms are free after a few hours to days. If giant cell arteritis is also present, a significantly higher dose must be used. The dose is only reduced if there are no symptoms. Maintenance therapy for at least one year is necessary to prevent recurrences . The dose can sometimes be reduced to as low as 2.5 mg / day. The aim is to reduce the dose to the lowest possible maintenance dose. The duration of therapy is around 18–24 months.
If treatment with corticosteroids alone does not produce satisfactory results, methotrexate can also be given. But here, too, the study situation does not justify standard treatment, and azathioprine is also not guaranteed.
Therapy goal
- Freedom from complaints
- Depression (BSR) <20 mm according to the Westergren method (1-hour value)
- C-reactive protein (CRP) <1 mg / dl
literature
- A. Bird et al: An evaluation of criteria for polymyalgia rheumatica. In: Annals of the Rheumatic Diseases . 1979, 38 (5), pp. 434-439.
Web links
- Diagnosis and differential diagnosis of myalgia in the guidelines of the German Society for Neurology
- F. Wermelinger: "Polymyalgia rheumatica" - a problematic diagnosis . In: Schweiz Med Forum No. 26, June 2002 pp. 623–630. (Description of the clinical picture. PDF file; 335 kB)
- Leaflet of the German Rheuma League (PDF file; 451 kB)
Individual evidence
- ↑ Jan V. Dequeker: polymyalgia rheumatica with Temporal arteritis, as Painted by Jan van Eyck in 1436. In: Canadian Medical Association Journal. Volume 124, No. 12, June 15, 1981, pp. 1597 f. PMC 1862532 (free full text)
- ^ TA Kermani: Polymyalgia rheumatica. In: The Lancet . 381, 2013, p. 63.
