Improved Diagnostics and Monitoring of Polymyalgia Rheumatica

Improved Diagnostics and Monitoring of Polymyalgia Rheumatica

Background: Polymyalgia rheumatica (PMR) is characterised by pain of the proximal muscles, general symptoms, and raised inflammatory markers. Treatment with prednisolone has several adverse effects. PMR is an exclusion diagnosis, and methods to diagnose and monitor the disease are lacking.

Objective: To investigate if ultrasound and PET/CT can be used to diagnose and monitor PMR. In addition, the importance of prednisolone induced adrenal insufficiency is investigated.

Methods: It is a prospective observational study in patients suspected of PMR. Patients diagnosed with PMR continue in the study. Ultrasound and PET/CT are performed at baseline, after 8 weeks on prednisolone, and after 10 weeks during a short prednisolone break. Adrenal insufficiency is investigated five times throughout the study. After one year the PMR diagnosis is confirmed.

Inclusion Criteria:

• Patients suspected of PMR.
• Age above 50
• Pain of the proximal muscles.

Exclusion Criteria:

• Peroral, intraarticular, intramuscular and dermal application of glucocorticoids within the last 3 month.
• Previous prednisolone treatment for GCA/PMR
• Unable to give consent.
• Symptoms of GCA (headache, jaw claudication, vision disturbances).
• Active malignant cancers within the last 5 years (except basal cell carcinoma).
• Other inflammatory rheumatic diseases (eg. rheumatoid arthritis, polymyositis, spondyloarthritis, psoriatic arthritits, gout).
• Uncontrolled diseases (eg severe active astma, cardiac disease with NYHA class IV)
• Treatment with peroral oestrogens, aminogluthethimid, trilostan, ketoconazole, fluconazol, etomidate, phenobarbital, phenytoin, rifampicin, metyrapon, mitotane.
• Known primary or secondary adrenal insufficiency.