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Vol. 7. Issue 3.
Pages 156-160 (May - June 2011)
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Vol. 7. Issue 3.
Pages 156-160 (May - June 2011)
Original article
DOI: 10.1016/S2173-5743(11)70034-X
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Conditions mimicking polymyalgia rheumatica
Enfermedades que simulan polimialgia reumática
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Federico Ceccatoa, Claudia Uñab, Mónica Regidorc, Oscar Rillob, Silvia Babinic, Sergio Pairaa,
Corresponding author
pairasergio@fibertel.com.ar

Corresponding author.
a Sección de Reumatología, Hospital J.M. Cullen, Santa Fe, Argentina
b Sección de Reumatología Hospital E. Tornú, Autonomous City of Buenos Aires, Buenos Aires, Argentina
c Sección de Reumatología, Hospital Privado de la Comunidad, Mar del Plata, Buenos Aires, Argentina
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Abstract
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Abstract
Objective

To examine the main clinical and laboratory data of patients initially diagnosed with polymyalgia rheumatica (PMR), which then developed another conditions.

Material and methods

We reviewed the clinical records of patients diagnosed with PMR in three hospitals in Argentina. Patients had a diagnosis of PMR if they met the following criteria: age50 years, erythrocyte sedimentation rate (ESR) at the time of diagnosis>40 mm, persistent pain and stiffness of at least one month of evolution in two of the following areas: neck, shoulders or proximal arms, hips or proximal lower limbs. Special attention was paid to symptoms or signs of “alarm (beginning or during disease progression) for suspecting the presence of other non PMR disease within a period of12 months.

Results

Sixteen of the 200 patients (8%) had other diseases during follow up. Malignancies (n=4) and rheumatic diseases (n=4) were the most common entities, in addition to infective endocarditis (n=1), narrow cervical canal (n=1), Parkinson's disease (n=1), statin-related myalgia (n=1), hypothyroidism (n=1), vitamin D deficiency (n=1) and Calcium Pyrophosphate Deposition Disease (CPPD) (n=2). The average length change of diagnosis was 4.5±3months. Ten patients had no response to steroids and two had persistently elevated ESR.

Conclusion

In this study we highlight the importance of recognizing signs and symptoms along with laboratory data and lack of response to treatment as suspects for the diagnosis of other disease manifestations in patients with PMR symptoms.

Keywords:
Polymyalgia rheumatic Neoplasms Rheumatic syndrome
Resumen
Objetivo

Observar las características clínicas y de laboratorio de pacientes con diagnóstico inicial de polimialgia reumática (PMR), que luego desarrollaron otra enfermedad.

Material y método

Se revisaron las historias clínicas de pacientes con diagnóstico de PMR de 3 hospitales de Argentina. Los pacientes tenían diagnóstico de PMR si cumplían con los siguientes criterios: edad > 50 años, velocidad de sedimentación globular (VSG)>40mm/h, dolor y rigidez persistente de al menos 1 mes de evolución en dos de las siguientes áreas: cuello o torso, hombros o región proximal de los brazos, caderas o región proximal de los miembros inferiores. Se prestó especial atención a los síntomas o signos de «alarma» que hicieran sospechar la presencia de otra enfermedad no PMR en un período12 meses.

Resultados

Se incluyó a 200 pacientes, de los cuales 16 (8%) presentaron otra enfermedad durante el seguimiento. Las enfermedades diagnosticadas fueron neoplasias (n=4) y enfermedades reumáticas (n=4), además de endocarditis infecciosa (n=1), canal estrecho cervical (n=1), enfermedad de Parkinson (n=1), mialgias relacionada con estatinas (n=1), hipotiroidismo (n=1), hipovitaminosis D (n=1) y artropatía por depósito de cristales de pirofosfato cálcico dihidratado (PFCD) (n=2). El tiempo medio±desviación estándar al cambio de diagnóstico fue 4,5±3 meses. Diez pacientes no tuvieron respuesta a esteroides y 2 sujetos presentaron VSG persistentemente elevada.

Conclusiones

En este trabajo resaltamos la importancia de reconocer signos y síntomas clínicos, junto con datos de laboratorio y falta de respuesta al tratamiento como sospecha para diagnóstico de otra enfermedad en pacientes con manifestaciones que simulan PMR.

Palabras clave:
Polimialgia reumática Neoplasias Síndromes reumáticos
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