Polymalagia Arthritis Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which cause pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdleas a result of the presence of a synovitis in proximal joints and periarticular structures, causing musculoskeletal symptoms in PMR.
Complications
1. Visual complications
There is a report of Four case histories are reported in which patients with polymyalgia rheumatica (polymyalgia
arteritic) developed evidence of cranial arteritis (in one case two
years and in one six months) following withdrawal of steroid therapy
after apparent cure(14).
2. Stroke
Polymyalgia rheumatica (PMR) is a
relatively common rheumatic disease, particularly in the elderly.
Vasculitis is associated with PMR and theoretically makes such patients
susceptible to vascular events such as stroke, according to study of
researchers at the Taipei Medical University(15)
3. Low back pain and MRI-abnormalities
Abnormalities in
shoulder and hip joints are most common, but signs of cervical and
lumbar interspinous bursitis might also be found in patients with
PMR(16).
4. Cervical interspinous bursitis
Cervical interspinous
bursitis is a likely basis for discomfort in the neck of patients with
PMR. The prominent inflammatory involvement of cervical bursae supports
the hypothesis that PMR is a disorder of prominent involvement of
extra-articular synovial structures. MRI evidence of interspinous
cervical bursitis was found in all patients with PMR, and in three
patients with fibromyalgia, in two with psoriatic spondylitis and one
with cervical osteoarthritis(17).
5. Renal failure
Renal involvement in PMR is extremely rare
and very few cases of AA amyloidosis secondary to PMR have been
described in literature. Dr. Javaid MM, and research team at the King’s
College Hospital NHS Foundation Trust, rpeort a case of a case of a
patient with history PMR who developed nephrotic range proteinuria and
rapidly deteriorating renal function secondary to AA amyloidosis
within 18 months of the onset of symptoms of PMR. This case reinforces
the association of PMR with secondary AA amyloidosis and highlights the
importance of monitoring renal function in patients with PMR(18).
6. Perforated colonic diverticular disease
Patients with polymyalgia
may have perforated colonic diverticular disease which mimics their
rheumatic pathology. In such cases steroid therapy, which is the
mainstay of polymyalgia therapy, can be detrimental.
Primary and hospital practitioners are encouraged to be vigilant
regarding non-specific gastrointestinal symptoms and consider
alternative diagnoses in those patients whose symptoms do not resolve
with standard therapy, as this can lead to an overall better
outcome(19)
7. Metastatic lymphoma
There is a report of A 48-year-old
HIV-positive woman presented with progressive pain and stiffness of
both shoulders and hips. She was given the diagnosis of polymyalgia rheumatica
(PMR) due to high erythrocyte sedimentation rate. However, a 1-week
course of prednisolone failed to improve her symptoms. She later
discovered a breast lump of which histopathological tissue was
consistent with a diffuse large B-cell lymphoma. Whole body bone scan
revealed multiple bony metastases(20).
8. Cancer
Patients hospitalized for PMR and GCA had a
marginally increased risk of cancer, with the highest risk noted for
the first year after hospitalization. However, for specific cancers,
such as skin cancer and leukaemia, the increases were still significant
for patients diagnosed later than 1 year after hospitalization(21)
9. Etc.
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Sources
(14) http://www.ncbi.nlm.nih.gov/pubmed/1223854
(15) http://www.ncbi.nlm.nih.gov/pubmed/22057203
(16) http://www.ncbi.nlm.nih.gov/pubmed/21262024
(17) http://www.ncbi.nlm.nih.gov/pubmed/18208867
(18) http://www.ncbi.nlm.nih.gov/pubmed/20969738
(19) http://www.ncbi.nlm.nih.gov/pubmed/20819228
(20) http://www.ncbi.nlm.nih.gov/pubmed/20686306
(21) http://www.ncbi.nlm.nih.gov/pubmed/20299378
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