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  • Treatment of polymyalgia rh...
    Castañeda, Santos; García-Castañeda, Noelia; Prieto-Peña, Diana; Martínez-Quintanilla, Dolores; Vicente, Esther F.; Blanco, Ricardo; González-Gay, Miguel A.

    Biochemical pharmacology, July 2019, 2019-07-00, 20190701, Letnik: 165
    Journal Article

    Relationship of PMR with GCA and other related inflammatory diseases in the elderly. DMARDs: disease-modifying anti-rheumatic drugs; EORA: elderly-onset rheumatoid arthritis; IL: interleukins (1, 6, 8); MCP-1: monocyte chemoattractant protein 1; NSAIDs: non-steroidal anti-inflammatory drugs; PMR: polymyalgia rheumatica; RS3PE: remitting seronegative symmetrical synovitis with pitting oedema syndrome; TNF-α: tumor necrosis factor alpha; Th: T-helper (Th1, Th17) lymphocytes; Treg: regulatory T lymphocytes. The two images at the center bottom show a subacromial bursitis and tenosynovitis of the biceps in a patient with PMR. The one on the right at the middle exemplifies the “halo sign” in a temporal artery of a patient with giant cell arteritis. Display omitted Polymyalgia rheumatica (PMR) is an inflammatory disease characterized by bilateral pain involving predominantly the shoulders and proximal aspects of the arms and less commonly the neck and the pelvic girdle. This review discusses briefly the main epidemiological data and clinical features of this condition. Especial attention is paid in the management of the disease. For this reason, both the classic management and the impact of new therapies are discussed in depth. In general, patients with PMR experience a rapid response to 12.5–25 mg/prednisone/day in less than a week. Patients with poor response to glucocorticoids or with relapsing disease require other therapies aimed mainly to spare glucocorticoids. Among them, methotrexate is the most commonly used. Nevertheless, different studies indicate that this agent yields only a modest effect. Biologic therapies against the main cytokines involved in the pathogenesis of the disease have been used in refractory patients. However, randomized controlled trials do not support the use of anti-tumor necrosis factor agents in PMR. In contrast, several case series and retrospective studies highlight the efficacy of the anti-interleukin-6 receptor tocilizumab in PMR. Nonetheless, controlled trials are needed to fully establish the beneficial effect of this agent. The potential favorable effect of the Janus-kinase inhibitors and new anti-interleukin-6 antagonists remains to be determined.