Rheumatic Polimialgia

Polimialgia fairly common rheumatic disease is of unknown etiology. It is characterized by proximal thigh and shoulder myalgia with morning stiffness that lasts more than an hour. Approximately 15% of patients with rheumatoid polimialgie develop giant cell arteritis and 50% of those with giant cell arteritis associated polimialgie rheumatoid shows.
Polimialgia is developing rheumatoid limited for several months to 5 years. Untreated patients shows a state of discomfort and malaise. The disease is not associated with severe complications.Patients treated with corticosteroids are at risk of side effects of long-term therapy. Relapses are common and occur in 25% of patients treated. All patients are at risk for giant cell arteritis.With appropriate treatment the survival rate is similar to that of people affected by the same age. rheumatic polimialgia is self-limiting and resolves within 1-3 years. Untreated patients shows a lower standard of living.
Pathogenesis:The cause is unknown polimialgiei rheumatic. HLA-DR4 haplotype is found with high frequency in people with rheumatoid polimialgie and in patients with giant cell arteritis and systemic monocyte activation is characteristic for both conditions. The disease is common in European natives indicating a genetic predisposition.An autoimmune process plays a role in rheumatoid polimialgia associating HLA-DR4 and high levels of IL-2 and IL-6. MRI shows tenosinvita subdeltoidiana, and bicipitala subacromiana. These findings indicate that noneroziva tenosynovitis and synovitis are responsible for many symptoms of the disease.
Signs and symptomsThe incidence increases with age. Rheumatic Polimialgia rarely affects people under 50 years. The average age of diagnosis is 72 years. Patients have a good health condition at onset, and 50% of patients had a sudden onset. In most girdle is first becomes symptomatic. The balance of the neck are also affected by the onset. In presenting symptoms may be unilateral but bilateral devind in a few weeks.Criteria for diagnosis:50-year-old debutBilateral morning stiffness, cramps for at least one month and affecting at least 2 to 3 areas: neck or torso, shoulders or arms, hip, or thigh-High erythrocyte sedimentation rateSymptom-responsive to corticosteroids.
Systemic manifestations include:-Moderate fever and weight loss-Malaise, fatigue and depression-Difficulty in rising from bed in the morning-Difficulty in getting out of a toilet-Difficulty in performing daily activities-Febrile episodes.
Musculoskeletal manifestations include:-Morning stiffness for more than an hourWith prolonged inactivity, muscle stiffnessCarpal-tunnel syndrome, Distal extremity swellingArthralgia and myalgia and development 6 months after the onset of systemic symptoms-Tenderness with limitation of movements in the proximal thigh or shoulder-Transient synovitis of the knee, and wrist joints sternoclaviculare-In late stages of muscle atrophy occurs with proximal muscle weakness and contractures of the shoulder capsule with limited active and passive movements.
DiagnosisLaboratory studies:Erythrocyte-sedimentation rate is the most sensitive study for rheumatoid polimialgia, although it is nonspecific-Is often raised above 40 mm / hC-reactive protein is increased along with ESR-Hemolucograma show normocytic anemia, normochromicThe apparent leukocytosis, thrombocytosisCreatinine kinase is normal and disease helps to distinguish primary polymyositis and other myopathiesAntinuclear antibodies and rheumatoid factor, are normal-IL-6 serum is high and indicates inflammatory activity of the disease.
Imaging Studies:Radiography painful joints often show abnormalities such as osteopenia, joint space coloabarea or erosion.MRI shows shoulder bursitis and subdeltoidiana subacromiala glenohumeral synovitis and the vast majority of patients. Hand tendon sheath inflammation is detected.Ultrasonography showed effusion in the stock exchange shoulder.It is a noninvasive technique and is useful when the diagnosis is uncertain.Temporal artery biopsy is indicated if it is suspected giant cell arteritis.The differential diagnosis is made with the following conditions: inflammatory amyloidosis, fibromyalgia, depression, hypothyroidism, giant cell arteritis, multiple myeloma, osteoarthritis, polymyositis, rheumatoid arthritis, synovitis, tendonitis, bursitis of the shoulder, cervical spondylosis.
TreatmentPolimialgia rheumatic disease is a chronic, self-limiting. The therapy is based on empirical experiences because they are less available in field trials to guide treatment. We want to control painful myalgia, improving stiffness and resolution of constitutional symptoms of the disease. Corticosteroids are considered the choice for complete resolution and reduction of ESR's normal.Disease is treatable at home. We recommend supplementing the diet with calcium and vitamin D if given corticosteroids.Osteopenia and osteoporosis are common in these patients. As relapses occur in the first 18 months of therapy and one year after stopping corticosteroids, all patients should be monitored for recurrence of symptoms up to 12 months after cessation of corticosteroid therapy. If NSAIDs are contraindicated, not without pain. Can be used alone in patients with mild symptoms.Methotrexate and other immunosuppressive agents are rarely used in rheumatic polimialgia. Occasionally indicated in patients with intolerance to corticosteroids.
Prognosis:Polimialgia is developing rheumatoid limited for several months to 5 years. Untreated patients shows a state of discomfort and malaise. The disease is not associated with severe complications.Patients treated with corticosteroids are at risk of side effects of long-term therapy. Relapses are common and occur in 25% of patients treated. All patients are at risk for giant cell arteritis.