Musculoskeletal manifestations in polymyalgia rheumatica and temporal arteritis

• Published in: Annals of the rheumatic diseases Vol. 60; no. 11; pp. 1060 - 1063
• Main Authors: Narváez, J, Nolla-Solé, J M, Narváez, J A, Clavaguera, M T, Valverde-García, J, Roig-Escofet, D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01-11-2001; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: Aged; Aged, 80 and over; Analysis; Aparell locomotor; Arteritis de cèl·lules gegants; Arthritis; Arthritis - etiology; Biological and medical sciences; Biopsy; Carpal Tunnel Syndrome - etiology; Complications and side effects; Concise Report; Demographic aspects; Disease; Diseases of the osteoarticular system; Edema; Edema - etiology; Female; Giant cell arteritis; Giant Cell Arteritis - complications; Humans; Inflamació; Inflammation; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Miàlgia; Musculoskeletal diseases; Musculoskeletal Diseases - etiology; Musculoskeletal system; Myalgia; Normal Distribution; Older people; Osteoarthritis; Patients; Polymyalgia rheumatica; Polymyalgia Rheumatica - complications; Prevalence studies (Epidemiology); Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Statistics, Nonparametric; Steroids; Synovitis - etiology; temporal arteritis; Europe; Spain; Human; Synovitis; Diseases of the osteoarticular system; Clinical form; Lower limb; Cardiovascular disease; Inflammation; Inflammatory joint disease; Arthritis; Epidemiology; Incidence; Vascular disease; Symptomatology; Chronic; Vasculitis; Limb; Polymyalgia rheumatica; Systemic disease; Arthropathy; Giant cell arteritis; Upper limb; Elderly; Public health
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.60.11.1060

OBJECTIVE To evaluate the incidence and characteristics of musculoskeletal manifestations in polymyalgia rheumatica (PMR) and temporal arteritis (TA). METHODS The records of 163 cases of PMR or TA diagnosed over a 15 year period in one area of Spain were reviewed for the presence and type of musculoskeletal manifestations. RESULTS Of 163 patients, 90 had isolated PMR and 73 had TA. Eighteen of the 90 patients (20%) with isolated PMR developed distal peripheral arthritis either at diagnosis or during the course of the disease. When it occurred, synovitis was mild, monoarticular or pauci-articular, asymmetrical, transient, and not destructive. Other distal manifestations observed in these patients were carpal tunnel syndrome and distal extremity swelling with pitting oedema. In all cases these manifestations occurred in conjunction with active PMR. As expected, PMR was the most frequent musculoskeletal manifestation in patients with TA, occurring in 56% of cases. On the contrary, only 11% of patients with TA developed peripheral arthritis. An important finding was that peripheral arthritis in these patients appears to be linked only temporally to the presence of simultaneous PMR and is not observed in its absence. Distal extremity swelling or defined polyarthritis were not observed. CONCLUSION The spectrum of distal musculoskeletal manifestations of PMR in our series is similar to that reported in other populations. By contrast, distal musculoskeletal symptoms are uncommon in TA. The almost complete absence of distal musculoskeletal manifestations in patients with pure TA suggests different mechanisms of disease in PMR and TA, supporting the view of two separate conditions or one common disease in which host susceptibility influences the clinical expression.