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Sunday, 24 November 2013

Polymalagia Arthritis - The Complications

Polymalagia Arthritis Polymalagia Arthritis is defined as a condition a common inflammatory rheumatic disease which cause pain, stiffness and tenderness in large muscles, including muscles shoulders and pelvic girdleas a result of the presence of a synovitis in proximal joints and periarticular structures, causing musculoskeletal symptoms in PMR.

Complications
1. Visual complications
There is a report of Four case histories are reported in which patients with polymyalgia rheumatica (polymyalgia arteritic) developed evidence of cranial arteritis (in one case two years and in one six months) following withdrawal of steroid therapy after apparent cure(14).
2. Stroke
Polymyalgia rheumatica (PMR) is a relatively common rheumatic disease, particularly in the elderly. Vasculitis is associated with PMR and theoretically makes such patients susceptible to vascular events such as stroke, according to study of  researchers at the Taipei Medical University(15)
3. Low back pain and MRI-abnormalities
Abnormalities in shoulder and hip joints are most common, but signs of cervical and lumbar interspinous bursitis might also be found in patients with PMR(16).
4. Cervical interspinous bursitis
Cervical interspinous bursitis is a likely basis for discomfort in the neck of patients with PMR. The prominent inflammatory involvement of cervical bursae supports the hypothesis that PMR is a disorder of prominent involvement of extra-articular synovial structures. MRI evidence of interspinous cervical bursitis was found in all patients with PMR, and in three patients with fibromyalgia, in two with psoriatic spondylitis and one with cervical osteoarthritis(17).
5. Renal failure
Renal involvement in PMR is extremely rare and very few cases of AA amyloidosis secondary to PMR have been described in literature. Dr. Javaid MM, and research team at the King’s College Hospital NHS Foundation Trust, rpeort a case of a case of a patient with history PMR who developed nephrotic range proteinuria and rapidly deteriorating renal function secondary to AA amyloidosis within 18 months of the onset of symptoms of PMR. This case reinforces the association of PMR with secondary AA amyloidosis and highlights the importance of monitoring renal function in patients with PMR(18).
6.  Perforated colonic diverticular disease
Patients with polymyalgia may have perforated colonic diverticular disease which mimics their rheumatic pathology. In such cases steroid therapy, which is the mainstay of polymyalgia therapy, can be detrimental. Primary and hospital practitioners are encouraged to be vigilant regarding non-specific gastrointestinal symptoms and consider alternative diagnoses in those patients whose symptoms do not resolve with standard therapy, as this can lead to an overall better outcome(19)
7. Metastatic lymphoma
There is a report of A 48-year-old HIV-positive woman presented with progressive pain and stiffness of both shoulders and hips. She was given the diagnosis of polymyalgia rheumatica (PMR) due to high erythrocyte sedimentation rate. However, a 1-week course of prednisolone failed to improve her symptoms. She later discovered a breast lump of which histopathological tissue was consistent with a diffuse large B-cell lymphoma. Whole body bone scan revealed multiple bony metastases(20).
8. Cancer
Patients hospitalized for PMR and GCA had a marginally increased risk of cancer, with the highest risk noted for the first year after hospitalization. However, for specific cancers, such as skin cancer and leukaemia, the increases were still significant for patients diagnosed later than 1 year after hospitalization(21)
9. Etc.
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Sources
(14) http://www.ncbi.nlm.nih.gov/pubmed/1223854
(15) http://www.ncbi.nlm.nih.gov/pubmed/22057203
(16) http://www.ncbi.nlm.nih.gov/pubmed/21262024
(17) http://www.ncbi.nlm.nih.gov/pubmed/18208867
(18) http://www.ncbi.nlm.nih.gov/pubmed/20969738
(19) http://www.ncbi.nlm.nih.gov/pubmed/20819228
(20) http://www.ncbi.nlm.nih.gov/pubmed/20686306
(21) http://www.ncbi.nlm.nih.gov/pubmed/20299378