RESEARCH - Peripheral musculoskeletal manifestations in polymyalgia rheumatica

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Peripheral Musculoskeletal Manifestations in Polymyalgia Rheumatica.

Original Article

JCR: Journal of Clinical Rheumatology. 12(4):167-171, August 2006.

Ceccato, Federico MD *; Roverano, a G. MD *; Papasidero, Silvia MD +;

Barrionuevo, Alejandra MD +; Rillo, L. MD +; Paira, O. MD *

Abstract:

Objectives: The objectives of this study were to evaluate the frequency and

characteristics of the peripheral musculoskeletal manifestations in

polymyalgia rheumatica (PMR), evaluate if PMR with peripheral synovitis

represents a subset with a more severe disease, and examine for clinical and

laboratory characteristics at onset of PMR that might later predict

rheumatoid arthritis (RA).

Patients and Methods: Patients were diagnosed with PMR according to the 1982

Chuang criteria. Patients were followed up between 1990 and 2002. The

following musculoskeletal manifestations at onset and during the follow up

were considered: peripheral synovitis, distal extremity swelling with

pitting edema, carpal tunnel syndrome, and distal tenosynovitis.

Results: Thirty-eight of the 74 patients (51%) showed distal musculoskeletal

symptoms: 29 (39%) had peripheral synovitis, 4 (5%) presented pitting edema,

4 (5%) experienced carpal tunnel syndrome, and one (1.3%) had distal

tenosynovitis. These manifestations resolved completely after corticosteroid

therapy was initiated. Peripheral synovitis was oligoarticular and often

transient. The joints most frequently involved were the wrist,

metacarpophalangeal, and knee. Erythrocyte sedimentation rate (ESR) was

normal in 7 patients. When comparing patients with PMR with and without

peripheral synovitis, no statistically significant differences were found in

the studied variables. Through the first year of follow up, 7 patients

fulfilled the American College of Rheumatology 1987 criteria for RA, 2

patients developed giant cell arteritis, and 3 had associated malignancy.

Patients who developed RA had statistically significantly increased presence

of persistent synovitis and a smaller decrease in mean ESR after treatment

with corticosteroids.

Conclusion: Fifty-one percent of the patients with PMR presented distal

musculoskeletal manifestations, with peripheral synovitis being the most

frequent one. Patients with PMR with peripheral synovitis did not represent

a high-risk subgroup with more severe disease. Seven patients who developed

criteria for seronegative RA within the first year of follow up had

presented statistically significant persistent synovitis compared with those

who continued as PMR and also showed a smaller initial decrease in mean ESR

after steroid treatment was initiated. The absence of persistent arthritis

and the benign course of the arthritis permit the distinction of PMR from

other inflammatory arthropathies.

© 2006 Lippincott & Wilkins, Inc.

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