About Kate Gilbert's book Polymyalgia Rheumatica (PGA) and Giant Cell Arteritis (GCA) 2nd edition
PMRGCAUK Is the UK organisation.
http://www.pmrgca.co.uk/content/home-page
https://www.facebook.com/pmrgcauk/
(PMR) Polymyalgia Rheumatica and (GCA) Giant Cell Arteritis
Prognosis
Despite therapy, relapses occur in approximately 50% of patients [Kremers et al. 2005a; Salvarani et al. 2005]. Several prospective studies have re-evaulated the final diagnosis in patients with PMR with between 2–30% of patients being diagnosed at a later date as having RA [Dasgupta et al. 1998; Caporali et al. 2001; Pease et al. 2005; Hutchings et al. 2007; Falsetti et al. 2011]. GC-related adverse events are common in patients with PMR [Gabriel et al. 1997; Hutchings et al. 2007; Mazzantini et al. 2012].
The risk of vascular disease (peripheral arterial disease, cardiovascular and cerebrovascular events) was increased in a systematic review of patients with PMR perhaps secondary to chronic inflammation or subclinical vasculitis [Hancock et al. 2012].
There are many reports of PMR in association with neoplasms, suggesting a paraneoplastic phenomenon. Several studies have evaluated this question. In a population-based study from Norway, malignancy risk was not increased in patients with PMR (also included GCA) compared with age- and gender-matched controls [Myklebust et al. 2002]. However, two database studies have suggested increased risk of cancer particularly in the first year of diagnosis. A database study from Sweden included 35,928 patients with GCA and PMR but this utilized the Swedish Hospital Discharge Register [Ji et al. 2010]. There was a marginal increase in the incidence of cancer in patients with GCA compared with the general population (standardized incidence ratio 1.19; 95% confidence interval 1.06–1.23) [Ji et al. 2010]. However, when evaluating malignancy risk in the first year after diagnosis of PMR or GCA, the standardized incidence ratio was 2.26 (95% confidence interval 2.10–2.42) [Ji et al. 2010]. Another study utilized the UK General Practice Research Database and evaluated cancer risk in 2877 patients with PMR compared with age- and sex-matched controls [Muller et al. 2013]. Over a median follow up of 7.8 years, 23.2% of patients with PMR developed cancer compared with 19.5% of controls [Muller et al. 2013]. The risk of malignancy was increased in patients with PMR during the first 6 months after diagnosis (hazard ratio 1.69; 95% confidence interval 1.18–2.42) [Muller et al. 2013]. Misdiagnosis may account for these findings and this highlights the importance of careful evaluation of patients presenting with polymyalgic symptoms to exclude other conditions. Another possibility is surveillance bias. Increased healthcare utilization has been reported in patients during the first year after diagnosis compared with the general population of age- and gender-matched controls [Kremers et al. 2005b]. Immune dysregulation which has been associated with increased risk of malignancy in other rheumatologic disease may also be at play. Caution should be used interpreting database studies since the diagnosis of PMR is not confirmed by chart review and the possibility of misclassification is a concern. One study included subjects with GCA in addition to PMR and used a hospital registry [Ji et al. 2010]. Overall survival in PMR is similar to or slightly better than the general population [Salvarani et al. 1995; Gran et al. 2001].
Conclusion
PMR is a common inflammatory condition affecting individuals aged 50 years and over. There is a close association between PMR and GCA. Given the absence of any diagnostic tests specific to PMR, careful consideration should be given to excluding other mimics, particularly SpA and RA. Ultrasonography of affected joints may complement the clinical evaluation for the diagnosis of PMR. Treatment consists of prolonged GC therapy, but relapses are common. Moreover, GCs are associated with significant morbidity. Evaluation of therapies targeting inflammatory cytokines as alternatives to GCs in PMR is underway.