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Published in Henry J. Woodford, Essential Geriatrics, 2022
PMR occurs in people over the age of 50, and 90% of cases present in those over 60 years. It is twice as common in women as men. It causes a slowly progressive pain and stiffness of the proximal muscles. Fever, malaise, night sweats, and weight loss are present in around a third of people. Morning stiffness lasting over 30 minutes is characteristic. A mild polyarthritis similar to rheumatoid arthritis may be seen. Diagnosis relies on the exclusion of other diseases. Inflammatory markers are elevated. The ESR is typically over 40 mm/hour, the serum C-reactive protein (CRP) is also likely to be elevated. Autoantibodies and CK are usually normal. There may be anaemia of chronic disease (two thirds of people) and abnormal liver enzymes (a third of people). Treatment is with steroids, typically prednisolone at a dose of 10–20 mg per day. The steroids can usually be slowly reduced and withdrawn over a period of several months. Bone protection should be considered for people on steroids (see Chapter 16).
Probabilistic reasoning
Published in Caroline J Rodgers, Richard Harrington, Helping Hands: An Introduction to Diagnostic Strategy and Clinical Reasoning, 2019
Caroline J Rodgers, Richard Harrington
Factors that increase the likelihood of RA are: A positive family history of RA.Female patient.Symmetrical distribution of the joints affected.Morning stiffness lasting over 30 minutes.A history of symptoms consistent with synovitis.Involvement of the feet.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
This condition is characterised by these main features: Back pain of insidious onset in males (10× more frequent than females) under 40 years of age.Morning stiffness, and the stiffness improves with movement/exercise.Present for more than 3 months.
Challenges in the diagnosis of polymyalgia rheumatica and related giant cell arteritis
Published in Expert Review of Clinical Immunology, 2023
Miguel A. González-Gay, Esther F. Vicente-Rabaneda, Juan A. Martínez-López, Raquel Largo, Elena Heras-Recuero, Santos Castañeda
It is important to emphasize that patients with PMR generally report that the pain is of recent onset. This gives some distinction from other common conditions like fibromyalgia, osteoarthritis. Although the clinical picture often develops acutely within a few days [4], patients may, for various reasons, present with some delay and report a different onset several weeks ago. However, this is different from pain that develops gradually or goes back years. In typical cases, patients complain of severe pain predominantly affecting the shoulder girdle and proximal arms bilaterally. Pain and stiffness affecting the neck, pelvic girdle, and proximal thighs are also common. These symptoms worsen at night and early in the morning with progressive improvement throughout the day. They aggravate after rest or when the patient is inactive for a long period of time [1]. Most activities of daily living like getting dressed or getting up from a chair, cause severe pain in the patients. Nighttime pain, malaise, fatigue, low-grade fever, anorexia, and weight loss are not uncommon [1]. Morning stiffness lasting longer than 45 to 60 minutes is also a typical feature.
State-of-the-art glucocorticoid-targeted drug therapies for the treatment of rheumatoid arthritis
Published in Expert Opinion on Pharmacotherapy, 2022
Eleftherios Pelechas, Alexandros A. Drosos
Lodotra®/RAYOS® took its first approval in Europe in March 2009 [26], while in July 2012, it was approved by the Food and Drug Administration (FDA). Among other indications Lodotra®/RAYOS® has been approved for the treatment of moderate-to-severe RA in adults. Due to its mechanism of action and its pharmacokinetics, patients that could benefit mostly from this formulation were those with morning stiffness. But, what is Lodotra®/RAYOS® and why using it? It is a relatively new formulation that uses a timed-released low-dose prednisone engineered to address the circadian rhythm of endogenous cortisol and disease symptoms, which cannot be achieved by conventional prednisone. Two trials, the Circadian Administration of Prednisone in RA 1 and 2 (CAPRA-1 and −2), have been used to extract data for its safety and its efficacy [22–27]. In CAPRA-1, a 12-week, multicentre, randomized, double-blind trial, researchers included 288 patients with active RA and compared the modified-release prednisone tablet with an immediate-release prednisone tablet. The results shown that the former formulation was better than the latter in terms of duration of morning stiffness and it was well-tolerated by the patients. In CAPRA-2, a 12-week, double-blind, placebo-controlled study, the researchers included 350 patients with active RA and compared the use of modified-released prednisone with placebo on top of their standard treatment with a disease-modifying anti-rheumatic drug (DMARD). The results shown that the former combination achieved higher response rates and greater reduction in morning stiffness than the latter.
Patient-reported outcomes and realistic clinical endpoints for JAK inhibitors in rheumatoid arthritis
Published in Expert Review of Clinical Immunology, 2022
When considering patient-reported outcomes (PROs), it is important to realize that the patient’s perspective of their daily burden of disease often differs from the physician’s perspective [1,2]. Health-Care Providers (HCPs) think of morning stiffness in RA and physical function, sleep disturbances, and pain at night. Patients experience the burden of disease throughout the day – which include fatigue and work impairment, depression and anxiety, limits in social functioning, and self-efficacy in coping and satisfaction/dissatisfaction with health and health care. Morning stiffness is important and may also occur later in the day. Pain can be a constant companion. Sleep disturbance and sexual satisfaction are often overlooked or not discussed. Since there exists a fair amount of discordance between what patients and physicians consider important in terms of defining disease activity and flares, it is important to assess PROs in clinical practice as well as trials.