Drs. Claire Owen, Anisha Dua, Stephen Paget, and Jack Cush discuss the diagnosis and monitoring of Polymyalgia Rheumatica (PMR), exploring topics such as using sedimentation rate as a diagnostic marker, the importance of biomarkers in diagnosis and monitoring, clinical presentation and response to treatment, challenges in diagnosing and monitoring PMR, the impact of serology on diagnosis, and the potential of advanced imaging techniques.
Monitoring PMR involves a combination of clinical assessment and biomarkers like sed rate and CRP, while future research may introduce more advanced biomarkers and imaging techniques for improved monitoring and treatment guidance.
A comprehensive patient history and examination are crucial for differentiating between PMR flare and steroid withdrawal, with factors such as strength, range of motion, and symptoms playing a significant role in accurate diagnosis.
While ultrasound is not currently a routine part of PMR diagnosis, studies suggest that it can aid in assessing disease severity and guiding treatment decisions, particularly for detecting signs of tenosynovitis.
Deep dives
Monitoring PMR: Clinical Assessment vs. Biomarkers
When monitoring patients with PMR, a combination of clinical assessment and biomarkers such as sed rate and CRP is commonly used. Some key clinical assessments include evaluating strength and range of motion in the shoulders and hips, observing the patient's movement and walking, and checking for symptoms such as morning stiffness. While biomarkers like IL-6 and imaging techniques such as ultrasound and MRI show promise, they are not routinely utilized in day-to-day practice. As future research develops, these biomarkers may play a larger role in monitoring disease activity and guiding treatment decisions.
Differentiating Flare from Steroid Withdrawal
When trying to differentiate PMR flare from steroid withdrawal, a comprehensive patient history and examination are crucial. Assessing the patient's strength, range of motion, and observing their mobility can provide valuable insights. Obtaining a detailed history, especially for symptoms associated with active PMR, helps differentiate between the two. Symptoms such as weakness, pain, and restricted movement should be carefully evaluated. Additionally, considering other factors such as platelet to lymphocyte ratio, adrenal insufficiency, hypotension, and nausea can aid in making a more accurate distinction.
The Future of Biomarkers in PMR
As research progresses, there is hope for the development of better biomarkers in PMR. Biomarkers such as SAA, S100 proteins, and cytokine profiles like IL-6, IL-12, and IL-23 show potential in discriminating between different conditions, predicting relapse or complications, monitoring disease activity, and guiding treatment decisions. While these biomarkers are not yet widely available or established in clinical practice, ongoing studies are exploring their utility. With the advancement of technology and medical understanding, the future may bring more accurate and efficient biomarkers for diagnosing and managing PMR.
Role of Ultrasound in PMR Diagnosis
Currently, the use of ultrasound is not a routine part of PMR diagnosis. Clinical assessments, such as evaluating symptoms, physical examinations, and monitoring inflammatory markers like sed rate and CRP, are the primary methods for diagnosing PMR. However, some studies have suggested that ultrasound can be helpful in assessing disease severity and guiding treatment decisions, particularly for detecting signs of tenosynovitis. Further research is needed to determine the overall value and standardization of ultrasound in PMR diagnosis.
Considerations for Monitoring PMR
Monitoring PMR involves a patient-centered approach that combines clinical assessment, including a detailed history, physical examination, and observation, along with the evaluation of biomarkers like sed rate and CRP. While research is ongoing to identify more specific biomarkers and imaging techniques like ultrasound, current practice mostly relies on the patient's symptoms, response to treatment, and inflammatory marker levels. Regular assessments, close patient follow-up, and collaboration between primary care doctors and rheumatologists contribute to the effective monitoring and management of PMR.
This Tuesday Night Rheumatology PMR panel discusses "Diagnosis and Monitoring". This PMR panel that includes Drs. Claire Owen, Anisha Dua, Stephen Paget and Jack Cush. Recorded on 10/3/2023
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