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Carlo Salvarani - One of the best experts on this subject based on the ideXlab platform.
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Discontinuation of therapies in Polymyalgia Rheumatica and giant cell arteritis.
Clinical and Experimental Rheumatology, 2013Co-Authors: Francesco Muratore, Nicolò Pipitone, Gene G Hunder, Carlo SalvaraniAbstract:Glucocorticoids are highly effective in treating Polymyalgia Rheumatica and giant cell arteritis, but their use is associated with numerous adverse events. Therefore, it is important to use them for the shortest period of time possible. The published evidence suggests that discontinuation of GC is feasible in a substantial number of patients with Polymyalgia Rheumatica and giant cell arteritis after an adequate period of treatment, provided that glucocorticoids are tapered gradually. Recurrences are relatively infrequent in Polymyalgia Rheumatica and somewhat more common in giant cell arteritis. Immunosuppressive agents may be used in patients with frequently relapsing or recurring disease to decrease exposure to glucocorticoids.
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Update on Polymyalgia Rheumatica
European Journal of Internal Medicine, 2013Co-Authors: Nicolò Pipitone, Carlo SalvaraniAbstract:Polymyalgia Rheumatica is an inflammatory disease of unknown etiology affecting individuals aged fifty years and older, mainly of Caucasian ethnicity. Polymyalgia Rheumatica is associated with giant cell arteritis more frequently than expected by chance alone. In both conditions, females are affected two to three times more often than males. The clinical hallmark manifestations of Polymyalgia Rheumatica are aching and morning stiffness in the shoulder girdle and often in the pelvic girdle and neck. Serum inflammatory markers are typically elevated, while the most consistent abnormal finding on imaging studies is bursitis in the symptomatic areas. A dramatic response to glucocorticoids is characteristic of Polymyalgia Rheumatica. Many patients are able to discontinue glucocorticoids six months to two years after the onset of clinical symptoms, but some patients may require longstanding glucocorticoid treatment. Glucocorticoid-sparing agents may be helpful in patients with chronic relapsing courses and those at high risk of glucocorticoid-related adverse events.
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Polymyalgia Rheumatica and giant cell arteritis
The Lancet, 2008Co-Authors: Carlo Salvarani, Fabrizio Cantini, Gene G HunderAbstract:Polymyalgia Rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of Polymyalgia Rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findings in giant-cell arteritis are broad, but commonly include visual loss, headache, scalp tenderness, jaw claudication, cerebrovascular accidents, aortic arch syndrome, thoracic aorta aneurysm, and dissection. Glucocorticosteroids are the cornerstone of treatment of both Polymyalgia Rheumatica and giant-cell arteritis. Some patients have a chronic course and might need glucocorticosteroids for several years. Adverse events of glucocorticosteroids affect more than 50% of patients. Trials of steroid-sparing drugs have yielded conflicting results. A greater understanding of the molecular mechanisms involved in the pathogenesis should provide new targets for therapy.
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Polymyalgia Rheumatica and giant cell arteritis
The New England Journal of Medicine, 2002Co-Authors: Carlo Salvarani, Fabrizio Cantini, Luigi Boiardi, Gene G HunderAbstract:Rheumatic diseases in the elderly are quite frequent, and their spectre largely varies. Some of them are typical of younger patients, having certain different clinical features if present in the elderly; others occur predominantly in the elderly patients. Typical diseases of the latter group are Polymyalgia Rheumatica (PMR) and giant cell arteritis (GCA).
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Diagnosis and Management of Polymyalgia Rheumatica/Giant Cell Arteritis
BioDrugs, 1998Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Luigi Macchioni, Luigi BoiardiAbstract:There are no standardised diagnostic criteria for Polymyalgia Rheumatica. The combination of persistent pain (at least 1 month) with marked morning stiffness in at least 2 of the neck, shoulder or pelvic girdle is characteristic of Polymyalgia Rheumatica. The other criteria are age >50 years, erythrocyte sedimentation rate (ESR) >40 mm/hour, rapid response to corticosteroids and an absence of other diseases capable of causing the musculoskeletal symptoms. A normal ESR does not exclude a diagnosis of Polymyalgia Rheumatica. Diagnostic temporal artery biopsy is recommended in all patients suspected of having giant cell arteritis. The segment of temporal artery with abnormality on physical examination should be biopsied.
Fabrizio Cantini - One of the best experts on this subject based on the ideXlab platform.
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Polymyalgia Rheumatica and giant cell arteritis
The Lancet, 2008Co-Authors: Carlo Salvarani, Fabrizio Cantini, Gene G HunderAbstract:Polymyalgia Rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of Polymyalgia Rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findings in giant-cell arteritis are broad, but commonly include visual loss, headache, scalp tenderness, jaw claudication, cerebrovascular accidents, aortic arch syndrome, thoracic aorta aneurysm, and dissection. Glucocorticosteroids are the cornerstone of treatment of both Polymyalgia Rheumatica and giant-cell arteritis. Some patients have a chronic course and might need glucocorticosteroids for several years. Adverse events of glucocorticosteroids affect more than 50% of patients. Trials of steroid-sparing drugs have yielded conflicting results. A greater understanding of the molecular mechanisms involved in the pathogenesis should provide new targets for therapy.
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Polymyalgia Rheumatica and giant cell arteritis
The New England Journal of Medicine, 2002Co-Authors: Carlo Salvarani, Fabrizio Cantini, Luigi Boiardi, Gene G HunderAbstract:Rheumatic diseases in the elderly are quite frequent, and their spectre largely varies. Some of them are typical of younger patients, having certain different clinical features if present in the elderly; others occur predominantly in the elderly patients. Typical diseases of the latter group are Polymyalgia Rheumatica (PMR) and giant cell arteritis (GCA).
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Diagnosis and Management of Polymyalgia Rheumatica/Giant Cell Arteritis
BioDrugs, 1998Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Luigi Macchioni, Luigi BoiardiAbstract:There are no standardised diagnostic criteria for Polymyalgia Rheumatica. The combination of persistent pain (at least 1 month) with marked morning stiffness in at least 2 of the neck, shoulder or pelvic girdle is characteristic of Polymyalgia Rheumatica. The other criteria are age >50 years, erythrocyte sedimentation rate (ESR) >40 mm/hour, rapid response to corticosteroids and an absence of other diseases capable of causing the musculoskeletal symptoms. A normal ESR does not exclude a diagnosis of Polymyalgia Rheumatica. Diagnostic temporal artery biopsy is recommended in all patients suspected of having giant cell arteritis. The segment of temporal artery with abnormality on physical examination should be biopsied.
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Proximal Bursitis in Active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. Objective: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of Polymyalgia Rheumatica. Design: Case-control study. Setting: 2 secondary referral centers of rheumatology. Patients: 13 case-patients who had active symptoms of Polymyalgia Rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. Measurements: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. Results: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had Polymyalgia Rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. Conclusions: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with Polymyalgia Rheumatica.
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proximal bursitis in active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be...
Gene G Hunder - One of the best experts on this subject based on the ideXlab platform.
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Discontinuation of therapies in Polymyalgia Rheumatica and giant cell arteritis.
Clinical and Experimental Rheumatology, 2013Co-Authors: Francesco Muratore, Nicolò Pipitone, Gene G Hunder, Carlo SalvaraniAbstract:Glucocorticoids are highly effective in treating Polymyalgia Rheumatica and giant cell arteritis, but their use is associated with numerous adverse events. Therefore, it is important to use them for the shortest period of time possible. The published evidence suggests that discontinuation of GC is feasible in a substantial number of patients with Polymyalgia Rheumatica and giant cell arteritis after an adequate period of treatment, provided that glucocorticoids are tapered gradually. Recurrences are relatively infrequent in Polymyalgia Rheumatica and somewhat more common in giant cell arteritis. Immunosuppressive agents may be used in patients with frequently relapsing or recurring disease to decrease exposure to glucocorticoids.
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Polymyalgia Rheumatica and giant cell arteritis
The Lancet, 2008Co-Authors: Carlo Salvarani, Fabrizio Cantini, Gene G HunderAbstract:Polymyalgia Rheumatica and giant-cell arteritis are closely related disorders that affect people of middle age and older. They frequently occur together. Both are syndromes of unknown cause, but genetic and environmental factors might have a role in their pathogenesis. The symptoms of Polymyalgia Rheumatica seem to be related to synovitis of proximal joints and extra-articular synovial structures. Giant-cell arteritis primarily affects the aorta and its extracranial branches. The clinical findings in giant-cell arteritis are broad, but commonly include visual loss, headache, scalp tenderness, jaw claudication, cerebrovascular accidents, aortic arch syndrome, thoracic aorta aneurysm, and dissection. Glucocorticosteroids are the cornerstone of treatment of both Polymyalgia Rheumatica and giant-cell arteritis. Some patients have a chronic course and might need glucocorticosteroids for several years. Adverse events of glucocorticosteroids affect more than 50% of patients. Trials of steroid-sparing drugs have yielded conflicting results. A greater understanding of the molecular mechanisms involved in the pathogenesis should provide new targets for therapy.
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Polymyalgia Rheumatica and giant cell arteritis
The New England Journal of Medicine, 2002Co-Authors: Carlo Salvarani, Fabrizio Cantini, Luigi Boiardi, Gene G HunderAbstract:Rheumatic diseases in the elderly are quite frequent, and their spectre largely varies. Some of them are typical of younger patients, having certain different clinical features if present in the elderly; others occur predominantly in the elderly patients. Typical diseases of the latter group are Polymyalgia Rheumatica (PMR) and giant cell arteritis (GCA).
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tissue cytokine patterns in patients with Polymyalgia Rheumatica and giant cell arteritis
Annals of Internal Medicine, 1994Co-Authors: Cornelia M Weyand, Gene G Hunder, Kevin C Hicok, Jorg J GoronzyAbstract:OBJECTIVE: To analyze temporal artery specimens from patients with giant cell arteritis and Polymyalgia Rheumatica for the presence of inflammatory cytokines and to ascertain whether a specific cytokine pattern exists for the two conditions. DESIGN: Case series of patients having temporal artery biopsy procedures. SETTING: The outpatient clinic and the research laboratories of the Division of Rheumatology, Mayo Clinic. PATIENTS: 34 patients having temporal artery biopsy procedures: 15 patients had giant cell arteritis, 9 had Polymyalgia Rheumatica without evidence of vasculitis, and 10 had neither Polymyalgia Rheumatica nor vasculitis. MEASUREMENT: Temporal artery specimens were analyzed for in vivo presence of cytokine messenger RNA (mRNA) by polymerase chain reaction with cytokine-specific primer sets. RESULTS: Vasculitic lesions in giant cell arteritis samples were characterized by in situ production of interleukin-1 beta, interleukin-6, and transforming growth factor-beta 1 mRNA (indicative of macrophage activation) and by interferon-gamma and interleukin-2 mRNA (indicative of selective T-cell activation). However, macrophage- and T-cell-derived cytokines were also detected in temporal artery biopsy specimens from patients with Polymyalgia Rheumatica. Tissue-infiltrating T cells in giant cell arteritis and Polymyalgia Rheumatica samples each had distinctive lymphokine profiles. Although interferon-gamma was found in 67% of giant cell arteritis samples, Polymyalgia Rheumatica samples had only interleukin-2. CONCLUSIONS: Patients with Polymyalgia Rheumatica have vascular involvement. Patients with Polymyalgia Rheumatica and giant cell arteritis share in situ production of mRNA specific for macrophage-derived cytokines. T cells recruited to vasculitic lesions in patients with giant cell arteritis predominantly produce interleukin-2 and interferon-gamma. Patients with Polymyalgia Rheumatica do not have interferon-gamma production, suggesting that interferon-gamma may be involved in the progression to overt arteritis.
Pietro Pavlica - One of the best experts on this subject based on the ideXlab platform.
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Proximal Bursitis in Active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. Objective: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of Polymyalgia Rheumatica. Design: Case-control study. Setting: 2 secondary referral centers of rheumatology. Patients: 13 case-patients who had active symptoms of Polymyalgia Rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. Measurements: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. Results: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had Polymyalgia Rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. Conclusions: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with Polymyalgia Rheumatica.
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proximal bursitis in active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be...
Luigi Macchioni - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis and Management of Polymyalgia Rheumatica/Giant Cell Arteritis
BioDrugs, 1998Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Luigi Macchioni, Luigi BoiardiAbstract:There are no standardised diagnostic criteria for Polymyalgia Rheumatica. The combination of persistent pain (at least 1 month) with marked morning stiffness in at least 2 of the neck, shoulder or pelvic girdle is characteristic of Polymyalgia Rheumatica. The other criteria are age >50 years, erythrocyte sedimentation rate (ESR) >40 mm/hour, rapid response to corticosteroids and an absence of other diseases capable of causing the musculoskeletal symptoms. A normal ESR does not exclude a diagnosis of Polymyalgia Rheumatica. Diagnostic temporal artery biopsy is recommended in all patients suspected of having giant cell arteritis. The segment of temporal artery with abnormality on physical examination should be biopsied.
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Proximal Bursitis in Active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be partially explained by the mild joint synovitis that is observed in these patients. Objective: To determine the involvement of the synovial structures of the shoulder girdle of patients who have active symptoms of Polymyalgia Rheumatica. Design: Case-control study. Setting: 2 secondary referral centers of rheumatology. Patients: 13 case-patients who had active symptoms of Polymyalgia Rheumatica seen during a 6-month period, 9 control-patients who had early symptoms of elderly-onset rheumatoid arthritis, and 10 age-matched healthy controls. Measurements: Magnetic resonance imaging of the shoulder was done on the 13 case-patients, 9 control-patients, and 10 healthy controls. Results: The frequency of subacromial and subdeltoid bursitis was significantly higher in the case-patients (who had Polymyalgia Rheumatica) than in the control-patients (who had elderly-onset rheumatoid arthritis). The frequencies of synovitis of the joints and tenosynovitis of the biceps did not significantly differ between the 13 case-patients and the 9 control-patients. None of the healthy controls showed evidence of fluid accumulation in the joints, bursae, or sheaths of the long head of the biceps. Conclusions: Inflammation of subacromial and subdeltoid bursae in association with synovitis of the glenohumeral joints and tenosynovitis of the biceps may contribute to the diffuse discomfort in the shoulder girdle observed in patients with Polymyalgia Rheumatica.
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proximal bursitis in active Polymyalgia Rheumatica
Annals of Internal Medicine, 1997Co-Authors: Carlo Salvarani, Fabrizio Cantini, Ignazio Olivieri, Libero Barozzi, Luigi Macchioni, Laura Niccoli, Angela Padula, Massimo De Matteis, Pietro PavlicaAbstract:Background: The cause of musculoskeletal symptoms in the proximal extremities of patients who have Polymyalgia Rheumatica is not completely understood. The diffuse and severe discomfort can only be...