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Unpopular opinion: spinach can be bad for you

PMR might be one of the most rewarding diagnoses to make in real practice: the patient comes to you in severe debilitating pain, and you prescribe steroids, giving them their lives back! As much as this impressive response makes your intervention appear almost magical, there is the often-forgotten story about the implications of such a diagnosis and treatment on patients' daily lives. 

What Causes PMR?

What causes polymyalgia rheumatica? It could be said that PMR occurs when trajectories of aging take a wrong turn, but it’s still not clear exactly what it is that causes this to happen. The ideas that follow will doubtless seem, to immunologists, vague and oversimplified; but even a partial picture might still offer a possible framework for clinicians and patients for thinking about treatment and care.

What Goes Wrong with the Immune System in PMR?

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease. The exact trigger for PMR onset remains unknown. However, immunology studies and clinical trials with biological DMARDs now shed light on the immune pathways involved in PMR.

Using Methotrexate in PMR

Treatment of PMR is still largely based on glucocorticoids. Where in other inflammatory rheumatic disorders, such as RA and PsA, early initiation of methotrexate is common practice, this is not the case in PMR. 

Frailty in PMR: Why do I need to care?

It is important to clarify that frailty is not a synonym of age (chronological age). Although there are only a few studies studying the impact of frailty in PMR, frailty is a relevant issue due to several important factors.

IL-6 Inhibitors in PMR: Give early or late?

It's exciting to be able to have this conversation because it's only in the past year that we have an approved non-corticosteroid therapy for PMR that's been shown to be effective in a well done clinical trial.

PMR: glad or bad tidings?

Please don’t tell your patient that PMR “typically” lasts two years. According to real-world data from the UK, one in four patients with PMR is prescribed steroids by their primary care physician for over four years. But nobody tells them this at the start, and that causes big problems later on.

Steroid Tapering in PMR: What's the Gold Standard?

Today I will be talking about the gold standard tapering of glucocorticoids and polymyalgia rheumatica or PMR. Now, whenever we talk about a gold standard, it gets tricky because in practice, so many factors influence the way that we approach glucocorticoids and tapering in PMR.

Screening and Overdiagnosis of ILD in RA

Dr. Michael Putman (Milwaukee, WI) reviews his approach to screening for ILD and RA, the potential for overdiagnosis and how this impacts treatment choices. Does this differ from your approach?

Focus on the Fasting Lipid Profile

How best do we communicate CV risk associated with RA to other members of the treating team, most particularly the primary care physicians? After some experimentation, I have come up with an approach that seems to work and which does not take up much time.

Comorbidities in RA: Focus on Difficult-to-Treat Disease

The presence of comorbidities naturally complicates treatment choice, patient adherence to medication and patient outcomes, increasing also the risk of making RA ‘difficult-to-treat’.

Infections Rheums Should Worry About

With the increasing development and use of new biologics and oral targeted therapies to treat RA and other immune mediated inflammatory diseases, an awareness of infection risk and prevention has become of increasing interest as well. While our patients may be susceptible to many different types of infections depending on immunosuppressive regimen, age and co-morbidities, I’ll highlight a few of the “usual suspects”.