Management of polymyalgia rheumatica in the primary health care setting: a comprehensive care report
DOI:
https://doi.org/10.29352/mill0220e.38393Keywords:
polymyalgia rheumatica; multimorbidity; primary health care; pain managementAbstract
Introduction: Polymyalgia Rheumatica (PMR) is a systemic inflammatory rheumatic disease of the adult, characterized by pain, morning stiffness, and a negative impact on daily activities.
Objective: To provide a comprehensive description of a clinical case of PMR in a complex patient within the Primary Health Care (PHC) setting.
Methods: This report follows the CARE guidelines, and appropriate patient consent was obtained. A 63-year-old male with multimorbidity presented with a two-week history of left hip pain. Two weeks later, and following two unsuccessful pharmacological treatments, he developed difficulty mobilizing the glenohumeral joints, along with morning stiffness in the shoulder and pelvic girdles lasting at least 30 minutes. Based on suggestive laboratory findings, a diagnosis of PMR was confirmed, and appropriate corticosteroid therapy was initiated.
Results: The initial symptoms represented an atypical presentation of PMR, leading to a delayed diagnosis. Adjustments to Diabetes Mellitus medication were required, as well as the implementation of prophylactic measures for corticosteroid-induced osteoporosis.
Conclusion: This case underscores the importance of considering PMR in the differential diagnosis of joint pain in the PHC setting. It demonstrates the essential role of the open-door policy characteristic of PHC in addressing non-specific pain complaints and highlights the Family Physician's expertise in managing patients with multimorbidity, including pain management.
Downloads
References
Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. The Lancet, 380(9836), 37–43. https://doi.org/10.1016/S0140-6736(12)60240-2
Branco, J.C., Rodrigues, A.M., & Gouveia, N., et al. (2016). Prevalence of rheumatic and musculoskeletal diseases and their impact on health-related quality of life, physical function and mental health in Portugal: results from EpiReumaPt– a national health survey. RMD Open, 2(1), e000166. https://doi.org/10.1136/rmdopen-2015-000166
Dasgupta, B., Cimmino, M.A., & Kremers, H.M., et al. (2012) 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum, 64(4), 943-954. https://doi.org/10.1002/art.34356
Dejaco, C., Singh, Y. P., Perel, P., Hutchings, A., Camellino, D., Mackie, S., Abril, A., Bachta, A., Balint, P., Barraclough, K., Bianconi, L., Buttgereit, F., Carsons, S., Ching, D., Cid, M., Cimmino, M., Diamantopoulos, A., Docken, W., Duftner, C., & Dasgupta, B. (2015). 2015 Recommendations for the management of polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Annals of the Rheumatic Diseases, 74(10), 1799. https://doi.org/10.1136/annrheumdis-2015-207492
Espígol-Frigolé G., Dejaco C., Mackie S. L., Salvarani C., Matteson E. L., & Cid M.C. (2023). Polymyalgia rheumatica. The Lancet, 402(10411), 1459–1472. https://doi.org/10.1016/S0140-6736(23)01310-7
Fortin, M., Stewart, M., Poitras, M.E., Almirall, J., & Maddocks, H. (2012). A Systematic Review of Prevalence Studies on Multimorbidity: Toward a More Uniform Methodology. The Annals of Family Medicine, 10 (2), 142-151. https://doi.org/10.1370/afm.1337
Gagnier, J. J., Kienle, G., Altman, D. G., Moher, D., Sox, H., Riley, D., & CARE Group* (2013). The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Global advances in health and medicine, 2(5), 38–43. https://doi.org/10.7453/gahmj.2013.008
González-Gay, M.A., García-Porrúa, C., Vázquez-Caruncho, M., Dababneh, A., Hajeer, A., & Ollier, W.E. (1999). The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a 10 year study. J Rheumatol, 26(6), 1326-32. https://pubmed.ncbi.nlm.nih.gov/10381051/
Gran, J.T., Myklebust, G., Wilsgaard, T., & Jacobsen, B.K. (2001). Survival in polymyalgia rheumatica and temporal arteritis: a study of 398 cases and matched population controls. Rheumatology (Oxford), 40(11), 1238-42. https://doi.org/10.1093/rheumatology/40.11.1238
Kermani, T.A., & Warrington, K.J. (2013). Polymyalgia rheumatica [published correction appears in Lancet. 2013 Jan 5;381(9860):28]. Lancet, 381(9860), 63-72. https://doi.org/10.1016/S0140-6736(12)60680-1
Mäntyselkä, P., Kumpusalo, E., Ahonen, R., Kumpusalo, A., Kauhanen, J., Viinamäki, H., Halonen, P., & Takala, J. (2001). Pain as a reason to visit the doctor: a study in Finnish primary health care. Pain, 89(2), 175-180. https://doi.org/10.1016/S0304-3959(00)00361-4
Muratore F. (2024). Clinical manifestations and diagnosis of polymyalgia rheumatica. UpToDate. Retrieved June 2, 2024. https://abrir.link/sVUeL
Nesher, G. (2014). Polymyalgia rheumatica--diagnosis and classification. J Autoimmun, 48-49:76-78. https://doi.org/10.1016/j.jaut.2014.01.016
Neves, C.M., Teixeira, H., & Granja, M. (2012). Polimialgia reumática: as dores que se multiplicam. Revista Portuguesa de Medicina Geral e Familiar, 28(3), 196-200. https://doi.org/10.32385/rpmgf.v28i3.10945
Salvarani, C., Gabriel, S.E., O'Fallon, W.M., & Hunder, G.G. (1995). Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, 1970-1991. Arthritis Rheum, 38(3), 369-73. https://doi.org/10.1002/art.1780380311
Salvarani, C., Cantini, F., Boiardi, L., & Hunder, G.G. (2002). Polymyalgia rheumatica and giant-cell arteritis . N Engl J Med, 347(4),261-271. https://doi.org/10.1056/NEJMra011913
Salvarani, C., Cantini, F., Boiardi, L., & Hunder, G.G. (2004). Polymyalgia rheumatica. Best Pract Res Clin Rheumatol, 18(5):705-722. https://doi.org/10.1016/j.berh.2004.06.003
Salvarani, C., Cantini, F., & Hunder, G.G. (2008). Polymyalgia rheumatica and giant-cell arteritis . Lancet, 372(9634): 234-45. https://doi.org/10.1016/S0140-6736(08)61077-6
Twohig, H., Mitchell, C., Mallen, C., Adebajo, A., & Mathers, N. (2015). “I suddenly felt I’d aged”: a qualitative study of patient experiences of polymyalgia rheumatica (PMR). Patient Educ Couns, 98(5):645-50. https://doi.org/10.1016/j.pec.2014.12.013
World Health Organization. (2016). Multimorbidity: Technical Series on Safer Primary Care. Geneva: World Health Organization. https://www.who.int/publications/i/item/9789241511650
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Millenium - Journal of Education, Technologies, and Health
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who submit proposals for this journal agree to the following terms:
a) Articles are published under the Licença Creative Commons (CC BY 4.0), in full open-access, without any cost or fees of any kind to the author or the reader;
b) The authors retain copyright and grant the journal right of first publication, allowing the free sharing of work, provided it is correctly attributed the authorship and initial publication in this journal;
c) The authors are permitted to take on additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, post it to an institutional repository or as a book), with an acknowledgment of its initial publication in this journal;
d) Authors are permitted and encouraged to publish and distribute their work online (eg, in institutional repositories or on their website) as it can lead to productive exchanges, as well as increase the impact and citation of published work
Documents required for submission
Article template (Editable format)
