Skip to main content
NCBI home page
Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2001 Nov;60(11):1021–1024. doi: 10.1136/ard.60.11.1021

Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like onset: a prospective study

R Caporali 1, C Montecucco 1, O Epis 1, F Bobbio-Pallavicin 1, T Maio 1, M Cimmino 1
PMCID: PMC1753411  PMID: 11602472

Abstract

OBJECTIVE—To evaluate in a prospective study whether patients with polymyalgia rheumatica (PMR) and patients with rheumatoid arthritis (RA) with PMR-like onset show distinctive clinical and laboratory features.
METHODS—A cohort of 116 consecutive patients with bilateral girdle pain for at least one month and raised erythrocyte sedimentation rate (ESR) was studied and followed up for 12 months. Laboratory tests included determination of ESR, IgM rheumatoid factor, haemoglobin, white blood cell count, platelet count, percentage of CD8 lymphocytes, serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and glutamyltransferase concentrations.
RESULTS—At first examination, RA was diagnosed in 22/116 (19%) patients and PMR in 94 (81%) patients. During the follow up period, 19 additional patients developed RA, and the diagnosis of PMR was confirmed in 65 (56%) patients at the end of the study. Of the clinical and laboratory features, only the presence of peripheral synovitis could differentiate patients who will develop RA from those with "true" PMR, but the positive predictive value of this feature was poor.
CONCLUSION—At present, there are no clinical or routine laboratory features allowing early differentiation between PMR and RA with PMR-like onset.



Full Text

The Full Text of this article is available as a PDF (123.9 KB).

Figure 1  .

Figure 1  

Open in a new tab

Diagnostic tree of the course of the disease in patients presenting with polymyalgia rheumatica (PMR)-like features, during 12 months of follow up. RA, Rheumatoid arthritis; PMR, polymyalgia, rheumatica. Three patients with cancer and three with giant cell arteritis.

Figure 2  .

Figure 2  

Open in a new tab

Kaplan-Meier curve showing the percentage of patients presenting with polymyalgia rheumatica (PMR)-like features (n = 116) whose diagnosis remained PMR during a one year follow up. *Number of patients with a new diagnosis of rheumatoid arthritis.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Al-Hussaini A. S., Swannell A. J. Peripheral joint involvement in polymyalgia rheumatica: a clinical study of 56 cases. Br J Rheumatol. 1985 Feb;24(1):27–30. doi: 10.1093/rheumatology/24.1.27. [DOI] [PubMed] [Google Scholar]
  2. Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
  3. BAGRATUNI L. Prognosis in the anarthritic rheumatoid syndrome. Br Med J. 1963 Feb 23;1(5329):513–518. doi: 10.1136/bmj.1.5329.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bahlas S., Ramos-Remus C., Davis P. Clinical outcome of 149 patients with polymyalgia rheumatica and giant cell arteritis. J Rheumatol. 1998 Jan;25(1):99–104. [PubMed] [Google Scholar]
  5. Boiardi L., Salvarani C., Macchioni P., Casadei Maldini M., Mancini R., Beltrandi E., Portioli I. CD8 lymphocyte subsets in active polymyalgia rheumatica: comparison with elderly-onset and adult rheumatoid arthritis and influence of prednisone therapy. Br J Rheumatol. 1996 Jul;35(7):642–648. doi: 10.1093/rheumatology/35.7.642. [DOI] [PubMed] [Google Scholar]
  6. Brito J., Biamonti G., Caporali R., Montecucco C. Autoantibodies to human nuclear lamin B2 protein. Epitope specificity in different autoimmune diseases. J Immunol. 1994 Sep 1;153(5):2268–2277. [PubMed] [Google Scholar]
  7. Chiaramonte M., Pupo A., Menegon T., Baldo V., Malatesta R., Trivello R. HBV and HCV infection among non-European Union immigrants in North-East Italy. Epidemiol Infect. 1998 Aug;121(1):179–183. doi: 10.1017/s0950268898001034. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Chuang T. Y., Hunder G. G., Ilstrup D. M., Kurland L. T. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982 Nov;97(5):672–680. doi: 10.7326/0003-4819-97-5-672. [DOI] [PubMed] [Google Scholar]
  9. Cid M. C., Ercilla G., Vilaseca J., Sanmarti R., Villalta J., Ingelmo M., Urbano-Marquez A. Polymyalgia rheumatica: a syndrome associated with HLA-DR4 antigen. Arthritis Rheum. 1988 May;31(5):678–682. doi: 10.1002/art.1780310515. [DOI] [PubMed] [Google Scholar]
  10. Combe B., Sany J., Le Quellec A., Clot J., Eliaou J. F. Distribution of HLA-DRB1 alleles of patients with polymyalgia rheumatica and giant cell arteritis in a Mediterranean population. J Rheumatol. 1998 Jan;25(1):94–98. [PubMed] [Google Scholar]
  11. Corrigall V. M., Dolan A. L., Panayi G. S. The value of percentage of CD8+ T lymphocyte levels in distinguishing polymyalgia rheumatica from early rheumatoid arthritis. J Rheumatol. 1995 Jun;22(6):1020–1024. [PubMed] [Google Scholar]
  12. Cupples L. A., Heeren T., Schatzkin A., Colton T. Multiple testing of hypotheses in comparing two groups. Ann Intern Med. 1984 Jan;100(1):122–129. doi: 10.7326/0003-4819-100-1-122. [DOI] [PubMed] [Google Scholar]
  13. Deal C. L., Meenan R. F., Goldenberg D. L., Anderson J. J., Sack B., Pastan R. S., Cohen A. S. The clinical features of elderly-onset rheumatoid arthritis. A comparison with younger-onset disease of similar duration. Arthritis Rheum. 1985 Sep;28(9):987–994. doi: 10.1002/art.1780280905. [DOI] [PubMed] [Google Scholar]
  14. Douglas W. A., Martin B. A., Morris J. H. Polymyalgia rheumatica: an arthroscopic study of the shoulder joint. Ann Rheum Dis. 1983 Jun;42(3):311–316. doi: 10.1136/ard.42.3.311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Ferri C., Greco F., Longombardo G., Palla P., Moretti A., Marzo E., Fosella P. V., Pasero G., Bombardieri S. Antibodies to hepatitis C virus in patients with mixed cryoglobulinemia. Arthritis Rheum. 1991 Dec;34(12):1606–1610. doi: 10.1002/art.1780341221. [DOI] [PubMed] [Google Scholar]
  16. Goldbach-Mansky R., Lee J., McCoy A., Hoxworth J., Yarboro C., Smolen J. S., Steiner G., Rosen A., Zhang C., Ménard H. A. Rheumatoid arthritis associated autoantibodies in patients with synovitis of recent onset. Arthritis Res. 2000 Mar 31;2(3):236–243. doi: 10.1186/ar93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Gonzalez-Gay M. A., Hajeer A. H., Dababneh A., Makki R., Garcia-Porrua C., Thomson W., Ollier W. Seronegative rheumatoid arthritis in elderly and polymyalgia rheumatica have similar patterns of HLA association. J Rheumatol. 2001 Jan;28(1):122–125. [PubMed] [Google Scholar]
  18. Gran J. T., Myklebust G. The incidence and clinical characteristics of peripheral arthritis in polymyalgia rheumatica and temporal arteritis: a prospective study of 231 cases. Rheumatology (Oxford) 2000 Mar;39(3):283–287. doi: 10.1093/rheumatology/39.3.283. [DOI] [PubMed] [Google Scholar]
  19. Harten P., Seyfarth B., Löffler H. Thrombocytosis in polymyalgia rheumatica: an additional diagnostic criterion and possible risk factor for ischemic complications? Arch Intern Med. 1998 Jan 12;158(1):95–97. doi: 10.1001/archinte.158.1.95-a. [DOI] [PubMed] [Google Scholar]
  20. Healey L. A. Long-term follow-up of polymyalgia rheumatica: evidence for synovitis. Semin Arthritis Rheum. 1984 May;13(4):322–328. doi: 10.1016/0049-0172(84)90012-x. [DOI] [PubMed] [Google Scholar]
  21. Healey L. A. Polymyalgia rheumatica and seronegative rheumatoid arthritis may be the same entity. J Rheumatol. 1992 Feb;19(2):270–272. [PubMed] [Google Scholar]
  22. Healey L. A. Polymyalgia rheumatica and the American Rheumatism Association criteria for rheumatoid arthritis. Arthritis Rheum. 1983 Dec;26(12):1417–1418. doi: 10.1002/art.1780261201. [DOI] [PubMed] [Google Scholar]
  23. Healey L. A., Sheets P. K. The relation of polymyalgia rheumatica to rheumatoid arthritis. J Rheumatol. 1988;15(5):750–752. [PubMed] [Google Scholar]
  24. Häntzschel H., Bird H. A., Seidel W., Krüger W., Neumann G., Schneider G., Wright V. Polymyalgia rheumatica and rheumatoid arthritis of the elderly: a clinical, laboratory, and scintigraphic comparison. Ann Rheum Dis. 1991 Sep;50(9):619–622. doi: 10.1136/ard.50.9.619. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Jones J. G., Hazleman B. L. Prognosis and management of polymyalgia rheumatica. Ann Rheum Dis. 1981 Feb;40(1):1–5. doi: 10.1136/ard.40.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Kassimos D., Kirwan J. R., Kyle V., Hazleman B., Dieppe P. Cytidine deaminase may be a useful marker in differentiating elderly onset rheumatoid arthritis from polymyalgia rheumatica/giant cell arteritis. Clin Exp Rheumatol. 1995 Sep-Oct;13(5):641–644. [PubMed] [Google Scholar]
  27. Lange U., Teichmann J., Stracke H., Bretzel R. G., Neeck G. Elderly onset rheumatoid arthritis and polymyalgia rheumatica: ultrasonographic study of the glenohumeral joints. Rheumatol Int. 1998;17(6):229–232. doi: 10.1007/s002960050039. [DOI] [PubMed] [Google Scholar]
  28. Meliconi R., Pulsatelli L., Uguccioni M., Salvarani C., Macchioni P., Melchiorri C., Focherini M. C., Frizziero L., Facchini A. Leukocyte infiltration in synovial tissue from the shoulder of patients with polymyalgia rheumatica. Quantitative analysis and influence of corticosteroid treatment. Arthritis Rheum. 1996 Jul;39(7):1199–1207. doi: 10.1002/art.1780390719. [DOI] [PubMed] [Google Scholar]
  29. Osella A. R., Sonzogni L., Cavallini A., Foti L., Guerra V., Di Leo A., Mondelli M. U., Misciagna G., Silini E. M. Molecular epidemiology of hepatitis C virus infection in an area of hyperendemicity in southern Italy: a population-based study. J Clin Microbiol. 1999 Jul;37(7):2371–2372. doi: 10.1128/jcm.37.7.2371-2372.1999. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Salvarani C., Cantini F., Macchioni P., Olivieri I., Niccoli L., Padula A., Boiardi L. Distal musculoskeletal manifestations in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 1998 Jul;41(7):1221–1226. doi: 10.1002/1529-0131(199807)41:7<1221::AID-ART12>3.0.CO;2-W. [DOI] [PubMed] [Google Scholar]
  32. van Schaardenburg D., Breedveld F. C. Elderly-onset rheumatoid arthritis. Semin Arthritis Rheum. 1994 Jun;23(6):367–378. doi: 10.1016/0049-0172(94)90087-6. [DOI] [PubMed] [Google Scholar]

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Publishing Group

RESOURCES