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Sunday, 24 November 2013

Polymalagia Arthritis - The Diagnosis

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.
Diagnosis
There is no specific test to diagnose polymyalgia rheumatica. The practice guideline for general practitioners (GPs) on polymyalgia rheumatica and temporal arteritis was published in February 2010 by the Dutch College of General Practitioners. This guideline provides GPs with recommendations for the diagnosis and treatment of polymyalgia rheumatica. After other disorders have been excluded, the diagnosis of ‘polymyalgia rheumatica’ is made in patients over the age of 50 who have bilateral pain in the neck and shoulder girdle and/or hip girdle that has lasted for longer than 4 weeks, morning stiffness that lasts longer than 60 minutes and an ESR > 40 mm in the first hour(22). Other researchers suggested that Diagnosis of rheumatologic disorders in the elderly is often complicated by the primary care clinician’s inability to differentiate among similar manifestations of rheumatologic disorders, the presence of comorbid conditions, and symptoms attributed simply to aging. A major consequence of the aches and pains associated with rheumatologic disorders, including polymyalgia rheumatica (PMR), is the impedance of activities of daily living, potentially leading to a loss of independence. PMR is common in the elderly. Often coexisting with PMR, temporal arteritis can lead to complications, including blindness, stroke, or cardiac sequelae. Timely detection and appropriate treatment of PMR in the elderly may improve quality of life, as well as deter irreversible problems. Patient education also has an important role(23).
If you are suspected to develop Polymalagia Arthritis, after a general physical exam, including the examination of shoulder motion, or swelling of the joints in the wrists, hands, etc., certain tests may be necessary
1. Blood test(24)
a. Erythrocyte sedimentation rate (ESR) is the blood test to exam the red blood cells in a test tube. he higher the ESR value is an indication of inflammation.
b.  C-reactive protein (CRP) 
Blood test measures the levels of C-reactive protein (CRP) produced by the liver in response to an injury or infection and people with polymyalgia rheumatic.
c. Blod test for thrombocytes 
Patient with polymyalgia rheumatica have an unusually high number of thrombocytosis. On the other hand, People with anemic polymyalgia rheumatica have a lower number of red blood cells than normal.
 d. Rheumatoid factor (RF)
RF is an antibody, a protein made by the immune system  presented in the blood of people with rheumatoid arthritis, but not in the blood of people with polymyalgia rheumatica.
2. Biopsy
Polymyalgia rheumatica is often associated with giant cell arteritis with biopsy by taking a small sample from the scalp artery in the emporal artery and examined under a microscope in a laboratory. Patients suspected of giant cell arteritis or polymyalgia rheumatica are often referred to the otolaryngologist for temporal artery biopsy. These patients may initially present to the otolaryngologist with symptoms referable to the head and neck(25).

3. Etc.
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Sources
(23) http://www.ncbi.nlm.nih.gov/pubmed/11858317
(24) http://web.archive.org/web/20080623203621/http://www.mayoclinic.com/health/polymyalgia-rheumatica/DS00441/DSECTION=tests-and-diagnosis
(25) http://www.ncbi.nlm.nih.gov/pubmed/3619280