Report of 6 Cases with Polymyalgia Rheumatica and a Review of the Literatures

Polymyalgia rheumatica (PMR) is a clinical syndrome of unknown cause that rarely occurs in persons less than 50 years old. Although the underlying pathological abnormality in PMR is not known, the association with vasculitis linked with the immunological abnormality is well established. The syndrome...

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Published inNihon Rōnen Igakkai zasshi Vol. 23; no. 5; pp. 469 - 476
Main Authors Nagura, Hiroshi, Tomonaga, Masanori, Kanemaru, Kazutomi, Ooyama, Toshiro
Format Journal Article
LanguageJapanese
Published The Japan Geriatrics Society 1986
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ISSN0300-9173
DOI10.3143/geriatrics.23.469

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Abstract Polymyalgia rheumatica (PMR) is a clinical syndrome of unknown cause that rarely occurs in persons less than 50 years old. Although the underlying pathological abnormality in PMR is not known, the association with vasculitis linked with the immunological abnormality is well established. The syndrome is characterized by aching and stiffness in the proximal portion of the extremities and torso, along with evidence of an underlying systemic inflammatory reaction. The latter is manifested by loss of weight, low grade fever, arthralgia and laboratory findings such as high ESR and increase of serum acute phase reactant. The clinical features and the laboratory findings of 6 aged patients with polymyalgia rheumatica, identified in our hospital during 9 year period 1975 to 1984, according to Hamrin's criteria, were characterized, comparing with those of the cases previously reported. Clinical and laboratory findings generally were similar to those in earlier studies except the lower frequency of temporal arteritis; Temporal artery biopsy (2 cases) or muscle biopsy (4 cases) were done and negative results. 2 cases among 6 cases, associated with dementia of vascular type or ptosis with external ophthalmoplegia, were also described in detail and discussed as to the possibility of the association of vasculitis. Immunological exams also did not support the previous studies suggesting that PMR might be linked with immunological abnormality.
AbstractList Polymyalgia rheumatica (PMR) is a clinical syndrome of unknown cause that rarely occurs in persons less than 50 years old. Although the underlying pathological abnormality in PMR is not known, the association with vasculitis linked with the immunological abnormality is well established. The syndrome is characterized by aching and stiffness in the proximal portion of the extremities and torso, along with evidence of an underlying systemic inflammatory reaction. The latter is manifested by loss of weight, low grade fever, arthralgia and laboratory findings such as high ESR and increase of serum acute phase reactant. The clinical features and the laboratory findings of 6 aged patients with polymyalgia rheumatica, identified in our hospital during 9 year period 1975 to 1984, according to Hamrin's criteria, were characterized, comparing with those of the cases previously reported. Clinical and laboratory findings generally were similar to those in earlier studies except the lower frequency of temporal arteritis; Temporal artery biopsy (2 cases) or muscle biopsy (4 cases) were done and negative results. 2 cases among 6 cases, associated with dementia of vascular type or ptosis with external ophthalmoplegia, were also described in detail and discussed as to the possibility of the association of vasculitis. Immunological exams also did not support the previous studies suggesting that PMR might be linked with immunological abnormality.
Author Nagura, Hiroshi
Ooyama, Toshiro
Tomonaga, Masanori
Kanemaru, Kazutomi
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  fullname: Tomonaga, Masanori
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  fullname: Kanemaru, Kazutomi
  organization: Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
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  fullname: Ooyama, Toshiro
  organization: Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital
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References 3) Hamrin B: Polymyalgia arteritica. Acta Med Scand 192 (Suppl 533): 1, 1972.
18) Lowenstein MB, Bridgeford PH, Vasey FB, Germain BF, Espinoza LR: Increased frequency HLA-DR3 and DR4 in polymyalgia rheumatica-giant cell arteritis. Arthritis Rheum 26: 925-927, 1983.
5) Liang GC, Simkin PA, Mannik M: Immunoglobulins in temporal arteritis: An immunofluorescent study. Ann Internm Med 81: 19-24, 1974.
20) Miller LD, Stevens MB: Skeletal manifestations of polymyalgia rheumatica. JAMA 240: 27-29, 1978.
6) Papaioannou CC, Gupta RC, hunder GG, McDuffile FC: Circulating immune complexes in giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 23: 1021-1025, 1980.
17) Hazleman B, Goldstone A, Voak D: Association of polymyalgia rheumatica and giant cell arteritis with HLA-B8. Br Med J 15: 989-991, 1977.
23) Henderson DRF, Dixon A ST. J: Synovitis in polymyalgia rheumatica. Rheumatol Rehabil 14: 244-250, 1975.
4) Fauchald P, Rygvold O, Øystese B: Temporal arteritis and polymyalgia rheumatica: Clinical and biopsy findings. Ann Intern Med 77: 845-852, 1972.
22) Nalbandian RM, Henry RL, Williams GA, et al: Polymyalgia rheumatica and giant cell arteritis-Rational diagnosis and treatment predirected on disordered prostaglandin metabolism. Medical Hypothesis 7: 1169-1182, 1981.
13) 高橋貞雄, 井上雅裕, 満田基温, 那須範満, 小松原良雄: Polymyalgia rheumatica の1例. リウマチ 21 (3): 220-226, 1981.
10) Reid AH, Maloney AFJ: Giant cell arteritis and arteriolitis associated with amyloid angiopathy in an elderly mongol. Acta Neuropath (Berl) 27: 131-137, 1974.
25) Dickson ER, Maldonado JE, Sheps SG, Chain JA: Systemic giant-cell arteritis with polymyalgia rheumatica. JAMA 224: 1496-1498, 1973.
16) Liang GC, Simkin PA, Hunder GG, Wilske KR, Healey LA: Familial aggregation of polymyalgia rheumatica and giant cell arteritis. Arthritis Rheum 17: 19-24, 1974.
26) Hazleman BL, Maclennan ICM, Esiri MM: Lymphocyte proliferation to artery antigen as a positive diagnostic test in polymyalgia rheumaticas. Ann Rheum Dis 34: 122-127, 1975.
8) Nightingale S, Venables GS, Bates D: Polymyalgia rheumatica with diffuse cerebral disease responding rapidly to steroid therapy. J Neurol Neurosurg Psychiatry 45: 841-843, 1982.
7) Bacon PA, Doherty SM: Hepatitis-B antibody in polymyalgia rheumatica. Lancet 13: 471-478, 1975.
19) Chuang TY, Hunder GG, Illstrup DM, Kurland LT: Polymyalgia rheumatica: A 10-year epidemiologic and clinical study. Ann Intern Med 97: 672-680, 1982.
9) 伊藤粋子, 広野茂: Polymyalgia rheumatica で発症し, 精神症状を伴った側頭動脈炎の1例. 内科 52: 169-172, 1983.
15) 関川巌. 奈須一, 高崎芳成, 橋本博史, 塩川優一, 滝和博: 血中 Immune complex 高値を認めた polymayalgia rheumatica の一例. 日本臨床免疫学会会誌 8: 40-46, 1985.
1) Bruce W: Senile rheumatic gout. Brit Med J 2: 811-813, 1888.
11) Dimant J, Grob D, Brunner NG: Ophthalmoplegia, ptosis, and miosis in temporal arteritis. Neurology (N. Y.) 30: 1054-1058, 1980.
2) Barber HS: Myalgia syndrome with constitutional effects. Polymyalgia rheumatics. Ann Rheum Dis 16: 230-237, 1957.
21) Myles AB: Polymyalgia rheumatica and giant cell arteritis: A seven-year survey. Rheumatol Rehabil 14: 231-235, 1975.
24) Boyle AC, Beatty DC: Polymyalgia rheumatica. Proc Roy Soc Med 54: 681-684, 1961.
14) 林俊治, 広瀬源二郎, 川田純也, 小田禄平, 小副川寛: Polymyalgia rheumatica 4症例の臨床的検討. 臨床神経 24: 901-907, 1984.
12) 高杉潔, 西原龍司: Temporal arteritis の合併が確認された polymyalgia rheumatica: 症状の提示と本邦報告例の文献的考察. 厚生省特定疾患系統的血管病変に関する調査研究報告, 厚生省, 東京, 1978, p229-238.
References_xml – reference: 12) 高杉潔, 西原龍司: Temporal arteritis の合併が確認された polymyalgia rheumatica: 症状の提示と本邦報告例の文献的考察. 厚生省特定疾患系統的血管病変に関する調査研究報告, 厚生省, 東京, 1978, p229-238.
– reference: 10) Reid AH, Maloney AFJ: Giant cell arteritis and arteriolitis associated with amyloid angiopathy in an elderly mongol. Acta Neuropath (Berl) 27: 131-137, 1974.
– reference: 4) Fauchald P, Rygvold O, Øystese B: Temporal arteritis and polymyalgia rheumatica: Clinical and biopsy findings. Ann Intern Med 77: 845-852, 1972.
– reference: 16) Liang GC, Simkin PA, Hunder GG, Wilske KR, Healey LA: Familial aggregation of polymyalgia rheumatica and giant cell arteritis. Arthritis Rheum 17: 19-24, 1974.
– reference: 9) 伊藤粋子, 広野茂: Polymyalgia rheumatica で発症し, 精神症状を伴った側頭動脈炎の1例. 内科 52: 169-172, 1983.
– reference: 21) Myles AB: Polymyalgia rheumatica and giant cell arteritis: A seven-year survey. Rheumatol Rehabil 14: 231-235, 1975.
– reference: 15) 関川巌. 奈須一, 高崎芳成, 橋本博史, 塩川優一, 滝和博: 血中 Immune complex 高値を認めた polymayalgia rheumatica の一例. 日本臨床免疫学会会誌 8: 40-46, 1985.
– reference: 20) Miller LD, Stevens MB: Skeletal manifestations of polymyalgia rheumatica. JAMA 240: 27-29, 1978.
– reference: 7) Bacon PA, Doherty SM: Hepatitis-B antibody in polymyalgia rheumatica. Lancet 13: 471-478, 1975.
– reference: 6) Papaioannou CC, Gupta RC, hunder GG, McDuffile FC: Circulating immune complexes in giant cell arteritis and polymyalgia rheumatica. Arthritis Rheum 23: 1021-1025, 1980.
– reference: 11) Dimant J, Grob D, Brunner NG: Ophthalmoplegia, ptosis, and miosis in temporal arteritis. Neurology (N. Y.) 30: 1054-1058, 1980.
– reference: 18) Lowenstein MB, Bridgeford PH, Vasey FB, Germain BF, Espinoza LR: Increased frequency HLA-DR3 and DR4 in polymyalgia rheumatica-giant cell arteritis. Arthritis Rheum 26: 925-927, 1983.
– reference: 13) 高橋貞雄, 井上雅裕, 満田基温, 那須範満, 小松原良雄: Polymyalgia rheumatica の1例. リウマチ 21 (3): 220-226, 1981.
– reference: 5) Liang GC, Simkin PA, Mannik M: Immunoglobulins in temporal arteritis: An immunofluorescent study. Ann Internm Med 81: 19-24, 1974.
– reference: 3) Hamrin B: Polymyalgia arteritica. Acta Med Scand 192 (Suppl 533): 1, 1972.
– reference: 24) Boyle AC, Beatty DC: Polymyalgia rheumatica. Proc Roy Soc Med 54: 681-684, 1961.
– reference: 8) Nightingale S, Venables GS, Bates D: Polymyalgia rheumatica with diffuse cerebral disease responding rapidly to steroid therapy. J Neurol Neurosurg Psychiatry 45: 841-843, 1982.
– reference: 2) Barber HS: Myalgia syndrome with constitutional effects. Polymyalgia rheumatics. Ann Rheum Dis 16: 230-237, 1957.
– reference: 17) Hazleman B, Goldstone A, Voak D: Association of polymyalgia rheumatica and giant cell arteritis with HLA-B8. Br Med J 15: 989-991, 1977.
– reference: 14) 林俊治, 広瀬源二郎, 川田純也, 小田禄平, 小副川寛: Polymyalgia rheumatica 4症例の臨床的検討. 臨床神経 24: 901-907, 1984.
– reference: 22) Nalbandian RM, Henry RL, Williams GA, et al: Polymyalgia rheumatica and giant cell arteritis-Rational diagnosis and treatment predirected on disordered prostaglandin metabolism. Medical Hypothesis 7: 1169-1182, 1981.
– reference: 25) Dickson ER, Maldonado JE, Sheps SG, Chain JA: Systemic giant-cell arteritis with polymyalgia rheumatica. JAMA 224: 1496-1498, 1973.
– reference: 1) Bruce W: Senile rheumatic gout. Brit Med J 2: 811-813, 1888.
– reference: 19) Chuang TY, Hunder GG, Illstrup DM, Kurland LT: Polymyalgia rheumatica: A 10-year epidemiologic and clinical study. Ann Intern Med 97: 672-680, 1982.
– reference: 23) Henderson DRF, Dixon A ST. J: Synovitis in polymyalgia rheumatica. Rheumatol Rehabil 14: 244-250, 1975.
– reference: 26) Hazleman BL, Maclennan ICM, Esiri MM: Lymphocyte proliferation to artery antigen as a positive diagnostic test in polymyalgia rheumaticas. Ann Rheum Dis 34: 122-127, 1975.
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SubjectTerms immnuological abnormality
polymyalgia rheumatica
vasculitis
Title Report of 6 Cases with Polymyalgia Rheumatica and a Review of the Literatures
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