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Polymyalgia rheumatica.
- Source :
-
Lancet (London, England) [Lancet] 2023 Oct 21; Vol. 402 (10411), pp. 1459-1472. Date of Electronic Publication: 2023 Oct 10. - Publication Year :
- 2023
-
Abstract
- Polymyalgia rheumatica is an inflammatory disease producing pain and stiffness, mainly in the shoulders and pelvic girdle, in people older than 50 years. Elevation of acute phase reactants is common due to the inflammatory nature of the disease. Since there are no specific diagnostic tests, diagnosis requires the exclusion of other diseases with similar presentations. Imaging has helped to identify the pathological substrate of polymyalgia rheumatica and it is increasingly used to support clinical diagnosis or to detect coexistent giant cell arteritis. Although polymyalgia rheumatica does not clearly impair survival or organ function, it can have a detrimental effect on quality of life. Glucocorticoids at 12·5-25·0 mg prednisone per day are effective in inducing remission in most individuals but, when tapered, relapses occur in 40-60% of those affected and side-effects are common. Assessment of disease activity can be difficult because pain related to common comorbidities such as osteoarthritis and tendinopathies, can return when glucocorticoids are reduced, and acute phase reactants are increased less during flares in individuals undergoing treatment or might increase for other reasons. The role of imaging in assessing disease activity is not yet completely defined. In the search for more efficient and safer therapies, tocilizumab and sarilumab have shown efficacy in randomised controlled trials and additional targeted therapies are emerging. However, judicious risk-benefit balance is essential in applying therapeutic innovations to people with polymyalgia rheumatica.<br />Competing Interests: Declaration of interests GE-F reports consulting fees from Janssen, GSK, and CSL Vifor, and meeting travel support from Boehringer Ingelheim. CD reports grant support from AbbVie, Novartis, and Celgene; consulting fees, speaker fees, or both honoraria from AbbVie, Roche, Sanofi, Galapagos, Lilly, Janssen, Novartis, and Sparrow; participation in advisory boards for Roche, Sanofi, AbbVie, Janssen, Novartis, Eli Lilly, Galapagos, and Sparrow; meeting travel support from AbbVie, Roche, Sanofi, Galapagos, Eli Lilly, Janssen, and Novartis; and royalties from Oxford University Press and SAGE journals. CD reports participation in the EULAR congress committee. SLM received a research grant from CSL Vifor and from the National Institute of Health Research; consulting fees from AbbVie, AstraZeneca, Roche/Chugai, and Sanofi; lecturing fees from Pfizer, UCB, and CSL Vifor; and meeting travel support from Roche/Chugai and Pfizer. SLM is a patron of the charity Polymyalgia Rheumatica and Giant Cell Arteritis UK. CS reports consulting fees from AbbVie, Boehringer Ingelheim, Roche, Lilly, Galapagos, Pfizer, Novartis, and Amgen, and royalties from UpToDate. ELM reports a research grant from AbbVie; consulting fees, lecturing fees, or both from Boehringer Ingelheim and Novartis; royalties from UpToDate; and speaker fees from Practice Point Communication. ELM reports participation in advisory boards for National Institutes of Health and Horizon Therapeutics. MCC reports consulting fees from GSK, AbbVie, CSL Vifor, Janssen, and AstraZeneca; royalties from UpToDate; and a research grant and meeting travel support from Kiniksa Pharmaceuticals. MCC reports participation in advisory boards for GSK, CSL Vifor, and AstraZeneca.<br /> (Copyright © 2023 Elsevier Ltd. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1474-547X
- Volume :
- 402
- Issue :
- 10411
- Database :
- MEDLINE
- Journal :
- Lancet (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 37832573
- Full Text :
- https://doi.org/10.1016/S0140-6736(23)01310-7