Introduction: Polymyalgia rheumatica is an increasingly common disease in older people, which gives rise to arthralgia and is mainly treated with corticosteroids. Patients in this age group also have a higher incidence of other co-morbidities including colonic pathology. Corticosteroid usage may mask signs of sepsis or complications secondary to intra-abdominal pathology, thereby delaying diagnosis and treatment, with eventual adverse outcome. These two cases highlight the importance of awareness and prompt recognition of this condition in order to avoid significant morbidity and mortality.
Case Presentation: CASE 1: A 73-year-old Caucasian woman with a diagnosis of polymyalgia presented with symptoms of an exacerbation in her right hip joint. Despite standard therapy with corticosteroids she failed to improve and started to develop features of widespread sepsis. Specific questioning revealed that, at the very onset of her symptoms, she had experienced mild diarrheal symptoms. Investigations revealed perforated diverticular disease with a peri-femoral abscess. CASE 2: A 69-year-old Caucasian woman with polymyalgia presented with left thigh pain and weakness associated with weight loss. A diagnosis of exacerbation of polymyalgia rheumatica was made and she was treated with corticosteroid therapy. Shortly afterwards she was admitted with generalized peritonitis. Laparotomy revealed a retroperitoneal abscess secondary to a perforated sigmoid colonic tumor.
Conclusions: 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.
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http://dx.doi.org/10.1186/1752-1947-4-299 | DOI Listing |
Arthritis Rheumatol
January 2025
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, 10117, Berlin, Germany.
Objective: An unmet need exists for glucocorticoid-sparing treatments for patients with polymyalgia rheumatica (PMR). The antibody-drug conjugate ABBV-154 comprises adalimumab conjugated to a glucocorticoid receptor modulator. We evaluated ABBV-154 versus placebo in patients with glucocorticoid-dependent PMR.
View Article and Find Full Text PDFJ Ultrasound
January 2025
Department of Physical Medicine and Rehabilitation, University of Health Science Fatih Sultan Mehmet Training and Research Hospital, E5 Karayolu Üzeri, İçerenköy-Ataşehir, 34752, Istanbul, Turkey.
Shoulder Injury Related to Vaccine Administration (SIRVA) is a complication caused by improperly administered vaccinations. It triggers an inflammatory cascade that damages shoulder structures, resulting in prolonged shoulder pain and restricted range of motion. Common diagnoses in SIRVA patients include shoulder bursitis (all classified as subacromial bursitis), adhesive capsulitis, and rotator cuff injuries such as tears or tendinopathy.
View Article and Find Full Text PDFMod Rheumatol
January 2025
Medical Affairs Department, Asahi Kasei Pharma Corporation, Tokyo, Japan.
Objectives: This study aimed to describe the characteristics, inflammatory markers as surrogates for disease activity, and treatment of patients with polymyalgia rheumatica (PMR) in Japan.
Methods: This cohort study analysed the data of 373 patients with PMR retrieved from an electronic medical records database in Japan. Patients were classified into quartiles, based on the daily glucocorticoid dose over the initial 90 days of treatment (Q1-Q4).
Lancet Rheumatol
January 2025
Department of Rheumatology, Hospital of Brunico, Teaching Hospital of the Paracelsius Medical University, Brunico 39031, Italy; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Medical University, Graz, Austria. Electronic address:
Lancet Rheumatol
January 2025
Department of Rheumatology, Université de Bretagne Occidentale, CHU Brest, INSERM (U1227), LabEx IGO Brest, France.
Background: Moderate doses of glucocorticoids result in improvements in nearly all patients with polymyalgia rheumatica, but related adverse events are common in older individuals. We aimed to evaluate whether treatment with baricitinib (a Janus kinase 1/2 inhibitor) results in disease control without the use of oral glucocorticoids in people with recent-onset polymyalgia rheumatica.
Methods: We conducted a randomised, double-blind, placebo-controlled, parallel-group trial at six expert centres in France.
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