Most Common Disease of elder: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Polymyalagia Arthritis (Rheumatica): The Causes

Kyle J. Norton (Scholar)

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Musculoskeletal disorders (MSDs) are  medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed(1).

      Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia

                     

                  Polymyalagia Arthritis (Rheumatica)


Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which causes pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdle as a result of the presence of a synovitis in proximal joints and periarticular structures.
                           

                              The causes 

The cause of PMR is not well understood, but researchers believe it is a result of the abnormal inflammatory activity of inflammatory cells and proteins of the immune system due to the presence of a synovitis in proximal joints and periarticular structures, causes by the following

1. Influenza B infection

Number of infectious agents have been found to induce the cause of polymyalagia rheumatica(PMR) associated to human leukocyte antigens (HLAs), such as HLA-DRB1 and HLA-DQB(10). According to the Kobe University Hospital, contracting influenza virus B is also found to influence to the development of PMR(9). Dr. Peris P said," Onset of symptoms in PMR is unrelated to seasonal pattern. Yet almost 50% of cases occurred in the months of May, February, and August"(12) and there is no association between infection and onset of polymyalgia rheumatica(13), the Ciudad Sanitaria y Universitaria de Bellvitge argued.

2. Genetic factors

In the study to evaluate HLA-DRB1 associations in patients with polymyalgi arheumatica (PMR), acording to the study based HLA-DRB1 genotyping in 89 PMR patients, 44 GCA patients, and 99 unrelated healthy controls from the same geographic area(10). Dr Pease CT and the research team at the University of Leeds, in the diagnosed of musculoskeletal disorder said, "the presence of HLA-DRB1*04 may indicate underlying RA or TA."(11)

3. Environmental factors

Environmental contagious factors have been found to link to the onset of at least 1/4 percent of the patient with PMR, according to the study of 460 patients (128 with isolated PMR, 227 with isolated GCA, 105 with PMR/CGA), by the Dupuytren University Hospital, Limoges(14).

According to the database of the World Health Organisation (WHO), statin, the prescribed medication for lowering blood cholesterol levels, using Anatomical Therapeutic Chemical (ATC) classification, may be may be associated with the occurrence of PMR(15).

Some researchers including Goëb V also concerned the risk of  Cerivastatin-induced PMR(16) and patient reexposure to a statin is also associated to the developed polymyalgia rheumatica(17).

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References
(9) HLA-DRB1 allele distribution in polymyalgia rheumatica and giant cell arteritis: influence on clinical subgroups and prognosis by Martínez-Taboda VM1, Bartolome MJ, Lopez-Hoyos M, Blanco R, Mata C, Calvo J, Corrales A, Rodriguez-Valverde V.(PubMed)
(10) HLA-DRB1 allele distribution in polymyalgia rheumatica and giant cell arteritis: influence on clinical subgroups and prognosis by Martínez-Taboda VM1, Bartolome MJ, Lopez-Hoyos M, Blanco R, Mata C, Calvo J, Corrales A, Rodriguez-Valverde V.(PubMed)
(11) Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms. A prospective longterm evaluation by Pease CT1, Haugeberg G, Morgan AW, Montague B, Hensor EM, Bhakta BB.(PubMed)
(12) Polymyalgia rheumatica is not seasonal in pattern and is unrelated to parvovirus b19 infection by Peris P1.(PubMed)
(13) Lack of association between infection and onset of polymyalgia rheumatica by Narváez J1, Clavaguera MT, Nolla-Solé JM, Valverde-Garcia J, Roig-Escofet D.(PubMed)
(14) Familial aggregation in giant cell arteritis and polymyalgia rheumatica: a comprehensive literature review including 4 new families by Liozon E1, Ouattara B, Rhaiem K, Ly K, Bezanahary H, Loustaud V, Letellier P, Drouet M, Vidal E.(PubMed)
(15) Statin-associated polymyalgia rheumatica. An analysis using WHO global individual case safety database: a case/non-case approach by de Jong HJ1, Saldi SR, Klungel OH, Vandebriel RJ, Souverein PC, Meyboom RH, Passier JL, van Loveren H, Cohen Tervaert JW.(PubMed)
(16) Cerivastatin-induced polymyalgia rheumatica-like illness by Goëb V, Guillemant N, Vittecoq O, Le Loët X.(PubMed)
(17) Giant cell arteritis and polymyalgia rheumatica after reexposure to a statin: a case report by de Jong HJ, Meyboom RH, Helle MJ, Klungel OH, Niskanen L, Cohen Tervaert JW.(PubMed)