Skip to main content

Advertisement

SpringerLink
Log in

Polymyalgia Rheumatica: a Common Disease in Seniors

  • Rheumatoid Arthritis (LW Moreland, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50 years of age along with evidence of an intense systemic inflammatory response. Although the above clinical symptoms are very characteristic for the condition, it can be mimicked by other autoimmune, infectious, malignant, and endocrine disorders chief among which are giant cell arteritis (GCA) and elderly-onset rheumatoid arthritis (EORA). Recently, PMR was reported in relation to treatment with immune checkpoint inhibitors.

Current treatment of PMR consists of low-to-medium doses of glucocorticosteroids (GC) with variable response rates and disease recurrence estimated to occur in 50% of patients while tapering down GC doses. In addition, GC-based regimens cause much of the morbidity associated with PMR in older adults, requiring close monitoring for GC-induced toxicity during therapy and highlighting the need for novel therapeutic strategies. Here, we review the latest findings in the field regarding specific etiologic factors, genetic associations, diagnostic methods, and advancements in treatment strategies and disease monitoring indices.

Recent Findings

Recent discoveries involving novel therapeutic targets in GCA have accelerated the study of PMR pathophysiology and have advanced treatment strategies in PMR management leading to current trials in IL-6 blocking agents.

Summary

PMR remains an enigmatic inflammatory condition affecting older adults, with current treatment approach causing much morbidity in this patient population. Advancements in our understanding of novel immunopathologic targets can serve as a solid foundation for future treatment strategies in the field.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Barber HS. Myalgic syndrome with constitutional effects; polymyalgia rheumatica. Ann Rheum Dis. 1957;16:230–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Michet CJ, Matteson EL. Polymyalgia rheumatica. BMJ. 2008;336:765–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Crowson CS, Matteson EL, Myasoedova E, Michet CJ, Ernste FC, Warrington KJ, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum. 2011;63:633–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Matteson EL, Dejaco C. Polymyalgia Rheumatica. Ann Intern Med. 2017;166:ITC65–80.

    Article  PubMed  Google Scholar 

  5. Dejaco C, Duftner C, Buttgereit F, Matteson EL, Dasgupta B. The spectrum of giant cell arteritis and polymyalgia rheumatica: revisiting the concept of the disease. Rheumatology. 2017;56:506–15.

    CAS  PubMed  Google Scholar 

  6. Dejaco C, Duftner C, Schirmer M. Are regulatory T-cells linked with aging? Exp Gerontol. 2006;41:339–45.

    Article  CAS  PubMed  Google Scholar 

  7. Franceschi C, Bonafè M, Valensin S, Olivieri F, De Luca M, Ottaviani E, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci. 2000;908:244–54.

    Article  CAS  PubMed  Google Scholar 

  8. Mohan SV, Liao YJ, Kim JW, Goronzy JJ, Weyand CM. Giant cell arteritis: immune and vascular aging as disease risk factors. Arthritis Res Ther. 2011;13:231.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Singh JA, Cleveland JD. The risk of polymyalgia rheumatica in older adults with gout: a Medicare claims study. Rheumatol Adv Pract. 2018;2.

  10. Samson M, Audia S, Fraszczak J, Trad M, Ornetti P, Lakomy D, et al. Th1 and Th17 lymphocytes expressing CD161 are implicated in giant cell arteritis and polymyalgia rheumatica pathogenesis. Arthritis Rheum. 2012;64:3788–98.

    Article  CAS  PubMed  Google Scholar 

  11. Stone JH, Klearman M, Collinson N. Trial of Tocilizumab in Giant-cell arteritis. N Engl J Med. 2017;377:1494–5.

    PubMed  Google Scholar 

  12. Salvarani C, Gabriel SE, O’Fallon WM, Hunder GG. The incidence of giant cell arteritis in Olmsted County, Minnesota: apparent fluctuations in a cyclic pattern. Ann Intern Med. 1995;123:192–4.

    Article  CAS  PubMed  Google Scholar 

  13. England BR, Mikuls TR, Xie F, Yang S, Chen L, Curtis JR. Herpes zoster as a risk factor for incident giant cell arteritis. Arthritis Rheum. 2017;69:2351–8.

    Article  CAS  Google Scholar 

  14. Castañeda S, García-Castañeda N, Prieto-Peña D, Martínez-Quintanilla D, Vicente EF, Blanco R, et al. Treatment of polymyalgia rheumatica. Biochem Pharmacol. 2019;165:221–9.

    Article  PubMed  CAS  Google Scholar 

  15. Salvarani C, Macchioni PL, Tartoni PL, Rossi F, Baricchi R, Castri C, et al. Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy. Clin Exp Rheumatol. 1987;5:205–15.

    CAS  PubMed  Google Scholar 

  16. Caylor TL, Perkins A. Recognition and management of polymyalgia rheumatica and giant cell arteritis. Am Fam Physician. 2013;88:676–84.

    PubMed  Google Scholar 

  17. Wise CM, Agudelo CA, Chmelewski WL, McKnight KM. Temporal arteritis with low erythrocyte sedimentation rate: a review of five cases. Arthritis Rheum. 1991;34:1571–4.

    Article  CAS  PubMed  Google Scholar 

  18. Hazleman B. Laboratory investigations useful in the evaluation of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). Clin Exp Rheumatol. 2000;18:S29–31.

    CAS  PubMed  Google Scholar 

  19. Chakravarty K, Pountain G, Merry P, Byron M, Hazleman B, Scott DG. A longitudinal study of anticardiolipin antibody in polymyalgia rheumatica and giant cell arteritis. J Rheumatol. 1995;22:1694–7.

    CAS  PubMed  Google Scholar 

  20. Patil P, Dasgupta B. Polymyalgia rheumatica in older adults. Aging Health. 2013;9:483–95.

    Article  CAS  Google Scholar 

  21. Camellino D, Cimmino MA. Are the new ACR/EULAR criteria the ultimate answer for polymyalgia rheumatica classification? J Rheumatol. 2016;43:836–8.

    Article  PubMed  Google Scholar 

  22. Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2015;67:2569–80.

    Article  Google Scholar 

  23. Dasgupta B, Cimmino MA, Maradit-Kremers H, Schmidt WA, Schirmer M, Salvarani C, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European league against rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2012;71:484–92.

    Article  PubMed  Google Scholar 

  24. Macchioni P, Boiardi L, Catanoso M, Pazzola G, Salvarani C. Performance of the new 2012 EULAR/ACR classification criteria for polymyalgia rheumatica: comparison with the previous criteria in a single-centre study. Ann Rheum Dis. 2014;73:1190–3.

    Article  PubMed  Google Scholar 

  25. Ozen G, Inanc N, Unal AU, Bas S, Kimyon G, Kisacik B, et al. Assessment of the new 2012 EULAR/ACR clinical classification criteria for polymyalgia rheumatica: a prospective multicenter study. J Rheumatol. 2016;43:893–900.

    Article  PubMed  Google Scholar 

  26. González-Gay, García-Porrúa, Salvarani, Olivieri, Hunder. Polymyalgia manifestations in different conditions mimicking polymyalgia rheumatica. Clin Exp Rheumatol. 2000;18:755–9.

    PubMed  Google Scholar 

  27. Ceccato F, Uña C, Regidor M, Rillo O, Babini S, Paira S. Conditions mimicking polymyalgia rheumatica. Reumatol Clin. 2011;7:156–60.

    Article  PubMed  Google Scholar 

  28. •• Partington R, Helliwell T, Muller S, Abdul Sultan A, Mallen C. Comorbidities in polymyalgia rheumatica: a systematic review. Arthritis Res Ther. 2018;20:258 This study is an excellent systematic review on the literature examining the prevalence of comorbidities associated with PMR.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Hancock AT, Mallen CD, Muller S, Belcher J, Roddy E, Helliwell T, et al. Risk of vascular events in patients with polymyalgia rheumatica. Can Med Assoc J. 2014;186:E495–501.

    Article  Google Scholar 

  30. Ungprasert P, Koster MJ, Warrington KJ, Matteson EL. Polymyalgia rheumatica and risk of coronary artery disease: a systematic review and meta-analysis of observational studies. Rheumatol Int. 2017;37:143–9.

    Article  PubMed  Google Scholar 

  31. Maradit Kremers H, Reinalda MS, Crowson CS, Davis JM, Hunder GG, Gabriel SE. Glucocorticoids and cardiovascular and cerebrovascular events in polymyalgia rheumatica. Arthritis Rheum. 2007;57:279–86.

    Article  PubMed  CAS  Google Scholar 

  32. Bowness P, Shotliff K, Middlemiss A, Myles AB. Prevalence of hypothyroidism in patients with polymyalgia rheumatica and giant cell arteritis. Br J Rheumatol. 1991;30:349–51.

    Article  CAS  PubMed  Google Scholar 

  33. Juchet H, Labarthe MP, Ollier S, Vilain C, Arlet P. Prevalence of hypothyroidism and hyperthyroidism in temporal arteritis and rhizomelic pseudopolyarthritis. A controlled study of 104 cases. Rev Rhum Ed Fr. 1993;60:493–8.

    CAS  PubMed  Google Scholar 

  34. Li X, Sundquist J, Sundquist K. Subsequent risks of Parkinson disease in patients with autoimmune and related disorders: a nationwide epidemiological study from Sweden. Neurodegener Dis. 2012;10:277–84.

    Article  CAS  PubMed  Google Scholar 

  35. Chakravarty E, Genovese MC. Rheumatic syndromes associated with malignancy. Curr Opin Rheumatol. 2003;15:35–43.

    Article  PubMed  Google Scholar 

  36. Muller S, Hider SL, Belcher J, Helliwell T, Mallen CD. Is cancer associated with polymyalgia rheumatica? A cohort study in the General Practice Research Database. Ann Rheum Dis. 2014;73:1769–73.

    Article  PubMed  Google Scholar 

  37. Ji J, Liu X, Sundquist K, Sundquist J, Hemminki K. Cancer risk in patients hospitalized with polymyalgia rheumatica and giant cell arteritis: a follow-up study in Sweden. Rheumatology. 2010;49:1158–63.

    Article  PubMed  Google Scholar 

  38. Pfeifer EC, Crowson CS, Major BT, Matteson EL. Polymyalgia rheumatica and its association with cancer. Rheumatology (Sunnyvale). 2015;Suppl 6.

  39. Myklebust G, Wilsgaard T, Jacobsen BK, Gran JT. No increased frequency of malignant neoplasms in polymyalgia rheumatica and temporal arteritis. A prospective longitudinal study of 398 cases and matched population controls. J Rheumatol. 2002;29:2143–7.

    PubMed  Google Scholar 

  40. Naschitz JE, Slobodin G, Yeshurun D, Rozenbaum M, Rosner I. Atypical polymyalgia rheumatica as a presentation of metastatic cancer. Arch Intern Med. 1997;157:2381.

    Article  CAS  PubMed  Google Scholar 

  41. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Olivieri I, Hunder GG. The spectrum of conditions mimicking polymyalgia rheumatica in northwestern Spain. J Rheumatol. 2000;27:2179–84.

    CAS  PubMed  Google Scholar 

  42. Gonzalez-Gay MA. Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum. 2004;33:289–93.

    Article  PubMed  Google Scholar 

  43. Blockmans D, De Ceuninck L, Vanderschueren S, Knockaert D, Mortelmans L, Bobbaers H. Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study in 35 patients. Rheumatology. 2007;46:672–7.

    Article  CAS  PubMed  Google Scholar 

  44. Schmidt WA, Gromnica-Ihle E. Incidence of temporal arteritis in patients with polymyalgia rheumatica: a prospective study using colour Doppler ultrasonography of the temporal arteries. Rheumatology. 2002;41:46–52.

    Article  CAS  PubMed  Google Scholar 

  45. Salvarani C, Cantini F, Hunder G. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372:234–45.

    Article  PubMed  Google Scholar 

  46. Laskou F, Coath F, Mackie SL, Banerjee S, Aung T, Dasgupta B. A probability score to aid the diagnosis of suspected giant cell arteritis. Clin Exp Rheumatol. 2019;37(Suppl 117):104–8.

    PubMed  Google Scholar 

  47. González-Gay MA, García-Porrúa C, Vázquez-Caruncho M. Polymyalgia rheumatica in biopsy proven giant cell arteritis does not constitute a different subset but differs from isolated polymyalgia rheumatica. J Rheumatol. 1998;25:1750–5.

    PubMed  Google Scholar 

  48. McCarty DJ, O’Duffy JD, Pearson L, Hunter JB. Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome. JAMA. 1985;254:2763–7.

    Article  CAS  PubMed  Google Scholar 

  49. Varshney AN, Singh NK. Syndrome of remitting seronegative symmetrical synovitis with pitting edema: a case series. J Postgrad Med. 2015;61:38–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Belloli L, Massarotti M, Marasini B. Polymyalgia rheumatica and elderly onset rheumatoid arthritis. J Clin Rheumatol. 2008;14:59.

    Article  PubMed  Google Scholar 

  51. Goldstein BL, Gedmintas L, Todd DJ. Drug-associated polymyalgia rheumatica/giant cell arteritis occurring in two patients after treatment with ipilimumab, an antagonist of ctla-4. Arthritis Rheum. 2014;66:768–9.

    Article  Google Scholar 

  52. Garel B, Kramkimel N, Trouvin A-P, Frantz C, Dupin N. Pembrolizumab-induced polymyalgia rheumatica in two patients with metastatic melanoma. Joint Bone Spine. 2017;84:233–4.

    Article  PubMed  Google Scholar 

  53. • Calabrese C, Cappelli LC, Kostine M, Kirchner E, Braaten T, Calabrese L. Polymyalgia rheumatica-like syndrome from checkpoint inhibitor therapy: case series and systematic review of the literature. RMD Open. 2019;5:e000906 This systematic review is unique in highlighting atypical clinical features of ICI-related PMR.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Belkhir R, Burel SL, Dunogeant L, Marabelle A, Hollebecque A, Besse B, et al. Rheumatoid arthritis and polymyalgia rheumatica occurring after immune checkpoint inhibitor treatment. Ann Rheum Dis. 2017;76:1747–50.

    Article  CAS  PubMed  Google Scholar 

  55. Zhang H, Watanabe R, Berry GJ, Vaglio A, Liao YJ, Warrington KJ, et al. Immunoinhibitory checkpoint deficiency in medium and large vessel vasculitis. Proc Natl Acad Sci U S A. 2017;114:E970–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. van Assen S, Agmon-Levin N, Elkayam O, Cervera R, Doran MF, Dougados M, et al. EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2011;70:414–22.

    Article  PubMed  CAS  Google Scholar 

  57. Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res. 2012;64:625–39.

    Article  CAS  Google Scholar 

  58. Dasgupta B, Borg FA, Hassan N, Barraclough K, Bourke B, Fulcher J, et al. BSR and BHPR guidelines for the management of polymyalgia rheumatica. Rheumatology. 2010;49:186–90.

    Article  PubMed  Google Scholar 

  59. Matteson EL, Maradit-Kremers H, Cimmino MA, Schmidt WA, Schirmer M, Salvarani C, et al. Patient-reported outcomes in polymyalgia rheumatica. J Rheumatol. 2012;39:795–803.

    Article  PubMed  Google Scholar 

  60. Hernández-Rodríguez J, Cid MC, López-Soto A, Espigol-Frigolé G, Bosch X. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med. 2009;169:1839–50.

    Article  PubMed  Google Scholar 

  61. Dasgupta B, Dolan AL, Panayi GS, Fernandes L. An initially double-blind controlled 96 week trial of depot methylprednisolone against oral prednisolone in the treatment of polymyalgia rheumatica. Br J Rheumatol. 1998;37:189–95.

    Article  CAS  PubMed  Google Scholar 

  62. Sundahl N, Bridelance J, Libert C, De Bosscher K, Beck IM. Selective glucocorticoid receptor modulation: new directions with non-steroidal scaffolds. Pharmacol Ther. 2015;152:28–41.

    Article  CAS  PubMed  Google Scholar 

  63. van den Hoven JM, Van Tomme SR, Metselaar JM, Nuijen B, Beijnen JH, Storm G. Liposomal drug formulations in the treatment of rheumatoid arthritis. Mol Pharm. 2011;8:1002–15.

    Article  PubMed  CAS  Google Scholar 

  64. Raine C, Stapleton PP, Merinopoulos D, Maw WW, Achilleos K, Gayford D, et al. A 26-week feasibility study comparing the efficacy and safety of modified-release prednisone with immediate-release prednisolone in newly diagnosed cases of giant cell arteritis. Int J Rheum Dis. 2018;21:285–91.

    Article  CAS  PubMed  Google Scholar 

  65. Ferraccioli G, Salaffi F, De Vita S, Casatta L, Bartoli E. Methotrexate in polymyalgia rheumatica: preliminary results of an open, randomized study. J Rheumatol. 1996;23:624–8.

    CAS  PubMed  Google Scholar 

  66. Caporali R, Cimmino MA, Ferraccioli G, Gerli R, Klersy C, Salvarani C, et al. Prednisone plus methotrexate for polymyalgia rheumatica: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2004;141:493–500.

    Article  CAS  PubMed  Google Scholar 

  67. De Silva M, Hazleman BL. Azathioprine in giant cell arteritis/polymyalgia rheumatica: a double-blind study. Ann Rheum Dis. 1986;45:136–8.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Adizie T, Christidis D, Dharmapaliah C, Borg F, Dasgupta B. Efficacy and tolerability of leflunomide in difficult-to-treat polymyalgia rheumatica and giant cell arteritis: a case series. Int J Clin Pract. 2012;66:906–9.

    Article  CAS  PubMed  Google Scholar 

  69. Diamantopoulos AP, Hetland H, Myklebust G. Leflunomide as a corticosteroid-sparing agent in giant cell arteritis and polymyalgia rheumatica: a case series. Biomed Res Int. 2013;2013:120638.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  70. Salvarani C, Macchioni P, Manzini C, Paolazzi G, Trotta A, Manganelli P, et al. Infliximab plus prednisone or placebo plus prednisone for the initial treatment of polymyalgia rheumatica: a randomized trial. Ann Intern Med. 2007;146:631–9.

    Article  PubMed  Google Scholar 

  71. Kreiner F, Galbo H. Effect of etanercept in polymyalgia rheumatica: a randomized controlled trial. Arthritis Res Ther. 2010;12:R176.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  72. Lally L, Forbess L, Hatzis C, Spiera R. Brief report: a prospective open-label phase IIa trial of tocilizumab in the treatment of polymyalgia rheumatica. Arthritis Rheum. 2016;68:2550–4.

    Article  CAS  Google Scholar 

  73. Devauchelle-Pensec V, Berthelot JM, Cornec D, Renaudineau Y, Marhadour T, Jousse-Joulin S, et al. Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study. Ann Rheum Dis. 2016;75:1506–10.

    Article  CAS  PubMed  Google Scholar 

  74. Langford CA, Cuthbertson D, Ytterberg SR, Khalidi N, Monach PA, Carette S, et al. A randomized, double-blind trial of abatacept (CTLA-4Ig) for the treatment of giant cell arteritis. Arthritis Rheum. 2017;69:837–45.

    Article  CAS  Google Scholar 

  75. O’Shea JJ, Kontzias A, Yamaoka K, Tanaka Y, Laurence A. Janus kinase inhibitors in autoimmune diseases. Ann Rheum Dis. 2013;72(Suppl 2):ii111–5.

    Article  PubMed  CAS  Google Scholar 

  76. Zhang H, Watanabe R, Berry GJ, Tian L, Goronzy JJ, Weyand CM. Inhibition of JAK-STAT signaling suppresses pathogenic immune responses in medium and large vessel vasculitis. Circulation. 2018;137:1934–48.

    Article  CAS  PubMed  Google Scholar 

  77. Dejaco C, Duftner C, Cimmino MA, Dasgupta B, Salvarani C, Crowson CS, et al. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis. 2011;70:447–53.

    Article  PubMed  Google Scholar 

  78. Leeb BF, Bird HA. A disease activity score for polymyalgia rheumatica. Ann Rheum Dis. 2004;63:1279–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Chuang TY, Hunder GG, Ilstrup DM, Kurland LT. Polymyalgia rheumatica: a 10-year epidemiologic and clinical study. Ann Intern Med. 1982;97:672–80.

    Article  CAS  PubMed  Google Scholar 

  80. Gran JT, Myklebust G, Wilsgaard T, Jacobsen BK. Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology. 2001;40:1238–42.

    Article  CAS  PubMed  Google Scholar 

  81. Doran MF, Crowson CS, O’Fallon WM, Hunder GG, Gabriel SE. Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. J Rheumatol. 2002;29:1694–7.

    PubMed  Google Scholar 

  82. Myklebust G, Wilsgaard T, Jacobsen BK, Gran JT. Causes of death in polymyalgia rheumatica. A prospective longitudinal study of 315 cases and matched population controls. Scand J Rheumatol. 2003;32:38–41.

    Article  PubMed  Google Scholar 

  83. Gabriel SE, Sunku J, Salvarani C, O’Fallon WM, Hunder GG. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Arthritis Rheum. 1997;40:1873–8.

    Article  CAS  PubMed  Google Scholar 

  84. Buckley L, Guyatt G, Fink HA, Cannon M, Grossman J, Hansen KE, et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum. 2017;69:1521–37.

    Article  Google Scholar 

  85. • Miloslavsky EM, Naden RP, Bijlsma JWJ, Brogan PA, Brown ES, Brunetta P, et al. Development of a glucocorticoid toxicity index (GTI) using multicriteria decision analysis. Ann Rheum Dis. 2017;76:543–6 This study is the official report delineating the development and outcome measures incorporated into the GTI.

    Article  PubMed  Google Scholar 

  86. Slobodin G, Rimar D, Boulman N, Kaly L, Rozenbaum M, Rosner I, et al. Acute sacroiliitis. Clin Rheumatol. 2016;35:851–6.

    Article  PubMed  Google Scholar 

  87. Gazitt T, Kibari A, Nasrallah N, Abu Elhija M, Zisman D. Polymyalgia rheumatica: the great imitator. Isr Med Assoc J. 2019;21:627–8.

    PubMed  Google Scholar 

  88. Mallia C, Coleiro B, Crockford M, Ellul B. Raynaud’s phenomenon caused by giant cell arteritis. A case report. Adv Exp Med Biol. 1999;455:517–20.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Rheumatology, University of Washington, Seattle, USA

    Tal Gazitt & Gregory Gardner

  2. Rheumatology Unit, Carmel Medical Center, Haifa, Israel

    Tal Gazitt & Devy Zisman

  3. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Devy Zisman

Authors
  1. Tal Gazitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Devy Zisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tal Gazitt.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

The patient’s written consent was obtained for the figures found in this manuscript.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Rheumatoid Arthritis

Electronic supplementary material

ESM 1

(DOC 115 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gazitt, T., Zisman, D. & Gardner, G. Polymyalgia Rheumatica: a Common Disease in Seniors. Curr Rheumatol Rep 22, 40 (2020). https://doi.org/10.1007/s11926-020-00919-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-020-00919-2

Keywords

Search

Navigation