Blogs
Advancing PMR
Even though polymyalgia rheumatica is not perceived by many physicians as a severe diagnosis, its diagnosis and management actually propose significant challenges. I'd like to talk about those challenges, and what directions our path forward can include to advance our understanding and improve the treatment of patients who have PMR.
When PMR Strikes Young, It Hits Hard
Narratives around polymyalgia rheumatica (PMR) often centre around “older people” or even “elderly”. And, indeed, the peak of the age distribution is in the mid-70s – not that everyone that age considers themselves old. Treating “young PMR” can be a very different proposition to treating someone in their seventies or eighties. It’s worth taking time to think this through.
Impact of glucocorticoids: more than just toxicity
As the sole effective treatment for polymyalgia rheumatica since their development in the 1950’s until recently, the impact of glucocorticoids and PMR outcomes are undeniably intertwined. So much so that when the OMERACT PMR working group first set out to develop a PMR core outcome set, they quickly realised that many of the outcomes important to patients were related to their glucocorticoid use.
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.
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.
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.
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”.
Comorbidities in Rheumatoid Arthritis: A Precarious Stack of Blocks
Comorbidities can pile up like a stack of blocks for people with rheumatoid arthritis (RA). At the time when RA is diagnosed, they already have more comorbidities than their peers, and after RA diagnosis they accumulate comorbidities faster than their peers.