Most Common Disease of 50 plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Polymyalagia Arthritis (Rheumatica): Misdiagnosis and delay diagnosis

Kyle J. Norton (Scholar)

Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
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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 Misdiagnosis and delay diagnosis

Polymyalgia rheumatica (PMR) is a very painful inflammatory disease, affecting the shoulder region and the pelvic girdle region in people over 50 year of age. But according to Dr, Talke M and Dr. Schmidt WA. said" the misdiganosis is common, .....taking a structured medical history and performing a thorough clinical examination are crucial" and  "patient with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels should be investigated particularly in patients who present with new onset bilateral shoulder pain and pronounced general impairment of movement"(84).

1. Spondyloarthropathy 

Late onset of  pondyloarthropathy, a disease characterized as a joint disease of the vertebral column is often misdiagnosed as Polymyalgia Rheumatica(PMR). According to the centre hospitalier d'Aulnay-sous-Bois, eight patients with spondyloarthropathy with poor response to corticosteroids and multiple flares,were misdiagnosed as PMR(85). The Gaziantep University study also showed the similarities of pondyloarthropathy and PMR in a patient of 50 year of age(86).

2. Osteoarthritis of the shoulders 

Osteoarthritis of the shoulders in some case may be wrongly diagnosis as PMR due to the relapse of the symptoms of similarity in both diseases(87), According to the Istituto di Ricovero e Cura a Carattere Scientifico, patients with PMR and pain in the shoulder is alo hound in 2 patients with spinal osteoarthritis(88).

3. Calcifying tendinitis of the rotator cuff
Calcifying tendinitis is disease characterized by a building-up of calcium in the rotator cuff (calcific deposit) in some case may be misdianosed as PMR(87).

4. Bursitis
Bursitis is an inflammation of a bursa of the knee, elbow or shoulder in some cases may be misdiagnosed as PMR(87). According to Asklepios Clinic, in the investigation of 54 consecutive patients with recent-onset PMR, over 30% with Subdeltoid bursitis(89).

5. Rheumatoid arthritis
Rheumatoid arthritis, a chronic inflammatory rheumatic diseases, found most often in the people age of 50 and over may be misdiagnosed as PMR(87). According to the Università di Pavia, the percentage of patient diagnosed with RA and PMR often change in first and during follow up diagnosis(90) due to like onset of patient with PMR.

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REFERENCES
(81) [Thrombocytosis in progressive generalized sclerosis (scleroderma) and in other rheumatic diseases].[Article in German] by Valentini G, Chianese U, Tirri G, Giordano M.(PubMed)
(82) Early recognition improves prognosis in elderly onset RA. by Negoescu A, Ostör AJ.(PubMed)
(83) Giant cell arteritis and polymyalgia rheumatica. Review for the otolaryngologist by Ferguson BJ, Allen NB, Farmer JC Jr.(PubMed)
(84) [Polymyalgia rheumatica in daily routine practice].[Article in German] by Talke M1, Schmidt WA.(PubMed)

(85) [Late onset spondyloarthropathy misdiagnosed as polymyalgia rheumatica].[Article in French] by Kouassi Djaha JM1, Jenvrin C, Dupont MP, Steiner J, de Bandt M.(PubMed)

(86) Late onset spondyloarthropathy mimicking polymyalgia rheumatica by Aydeniz A1, Altındağ O, Oğüt E, Gürsoy S.(PubMed)

(87) [Polymyalgia rheumatica in daily routine practice].[Article in German] by Talke M1, Schmidt WA(PubMed)

(88) Lumbar interspinous bursitis in active polymyalgia rheumatica by Salvarani C1, Barozzi L, Boiardi L, Pipitone N, Bajocchi GL, Macchioni PL, Catanoso M, Pazzola G, Valentino M, De Luca C, Hunder GG.(PubMed)

(89) Joint involvement in patients with early polymyalgia rheumatica using high-resolution ultrasound and its contribution to the EULAR/ACR 2012 classification criteria for polymyalgia rheumatica by Weigand S1, Ehrenstein B, Fleck M, Hartung W.(PubMed)

(90) Presenting features of polymyalgia rheumatica (PMR) and rheumatoid arthritis with PMR-like onset: a prospective study by Caporali R1, Montecucco C, Epis O, Bobbio-Pallavicini F, Maio T, Cimmino MA.(PubMed)