EDITORIAL - Polymyalgia rheumatica versus late-onset RA

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Rheumatology 2009 48(2):93-95; doi:10.1093/rheumatology/ken294

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EDITORIALS

Polymyalgia rheumatica vs late-onset rheumatoid arthritis

M. Cutolo1, M. A. Cimmino1 and A. Sulli1

1Research Laboratory and Academic Unit of Clinical Rheumatology,

Department of Internal Medicine, University of Genova, Genova, Italy

Polymyalgia rheumatica differs from RA

Polymyalgia rheumatica (PMR) is a well-defined acute musculoskeletal

inflammation of ageing people and characterized by clinical symptoms

that may create some difficulties in the differential diagnosis with

late (elderly) onset RA (LO-RA or EO-RA, respectively) as well as with

LO-RA with PMR-like onset (LO-RA/PMR) [1].

PMR as an inflammatory condition of multifactorial aetiology is

generally characterized at least at the beginning by aching and

stiffness in the shoulder and in the pelvic girdles. It occurs in

people over the age of 50–60 yrs, and it usually responds rapidly to

low doses of glucocorticoids and has a favourable prognosis. Genetic

causes and polymorphisms of additional genes involved in the

initiation and regulation of inflammatory reaction have been

considered to be possible susceptibility factors for PMR [2]. In

particular, TNF-, and IL-1 receptor antagonist (IL-1Ra) gene

polymorphisms are predisposing factors and may be implicated in the

pathogenesis of PMR [3]. On the other hand, increased production of

IL-6 is a characteristic finding in patients with PMR, and

glucocorticoids rapidly reduce serum levels of IL-6 [4]. The

suppression of the hypothalamic–pituitary–adrenal (HPA) axis as

consequence of chronic stress and/or the endocrino-senescence could

contribute to the pathogenesis of PMR [5]. Recently, a reduced

production of adrenal hormones, like cortisol (CO) and DHEAS, has been

shown in untreated PMR patients with active disease, as well as an

increased 17-hydroxy-progesterone (PRG) production following

adrenocorticotrophic hormone (ACTH) testing [6].

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Read the full article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/48/2/93?etoc

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