Erythrocyte sedimentation rate and C reactive protein in the assessment of polymyalgia rheumatica/giant cell arteritis on presentation and during follow up

Article Abstract:

Polymyalgia rheumatica (PMR) is a condition involving pain in the muscles of the shoulder and pelvis and an increased erythrocyte sedimentation rate (ESR), the speed at which red blood cells settle under laboratory conditions. Low doses of corticosteroids are effective in relieving symptoms and reducing the erythrocyte sedimentation rate. Patients with PMR may develop giant cell arteritis (GCA), a chronic inflammation of the blood vessels associated with the accumulation of giant cells, which are commonly found in inflamed tissues. Patients with both PMR and GCA require larger doses of corticosteroids than patients with only PMR. The usefulness of ESR and C reactive protein (CRP), a liver protein that serves as a marker for tissue damage, in assessing disease activity and predicting relapse was studied. Seventy-four patients with PMR and GCA were tested for ESR and CRP before and during treatment with the corticosteroid prednisolone. Before treatment began, ESR was increased in all cases and CRP was elevated in 49 of 55 cases. The ESR was a better indicator of disease activity except in patients whose symptoms had resolved completely after only one week of treatment. There were few false-positive results with either measure. During relapse, ESR was normal in 37 of 77 cases and CRP was normal in 41 of 73 cases. The findings indicate that erythrocyte sedimentation rate is the most accurate laboratory indicator of disease activity in polymyalgia rheumatica and giant cell arteritis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Giant cell arteritis, Temporal arteritis, Blood cell count

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A seasonal pattern in the onset of polymyalgia rheumatica

Article Abstract:

Polymyalgia rheumatica (PMR) is a disease characterized by pain and stiffness in the shoulder and pelvic bones and a marked acute phase response. The cause of PMR is not known, but may be related to genetic and immune factors or infection with the hepatitis B virus. PMR is often preceded by sudden and severe symptoms, such that patients can often recall the exact date of onset. Although PMR has been reported to occur more frequently in the summer and winter, other studies have been unable to demonstrate a seasonal trend in the onset of this disease. A possible seasonal distribution was assessed in 58 patients with PMR, and in 44 patients with elderly onset rheumatoid arthritis (EORA), an inflammatory joint disease occurring at an advanced age. In addition, the importance of seasonal variation in distinguishing PMR from EORA was evaluated. Thirty-six cases of PMR (62 percent) and 14 cases of EORA (31 percent) developed between May and August. No seasonal variation in the distribution of EORA was found. The monthly occurrence of PMR was related to the outside temperature and hours of sunshine. These results suggest that PMR may be activated by factors such as actinic damage, or tissue injury due to sunlight, specifically involving the surface blood vessels. Infective agents with a seasonal cycle may also be responsible for the seasonal variation in PMR. The more frequent occurrence of PMR in the summer may be helpful in distinguishing PMR from EORA. (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Environmental aspects, Rheumatoid arthritis, Seasonal variations (Diseases)

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Lysylhydroxylation and non-reducible crosslinking of human supraspinatus tendon collagen: changes with age and in chronic rotator cuff tendinitis

Article Abstract:

Injury, rather than age-related changes, may cause degradations in the quality of collagen in shoulder tendons. Researchers examined cadaveric tendon samples and determined that normal physiologic changes occurred with age, but that the collagen did not fundamentally change. Injured tendons showed an accumulation of substances indicating impaired healing of microruptures in the tendon. Healed collagen was structurally less stable, which may predispose patients with rotator cuff injuries to chronic symptoms.

Netherlands, Physiological aspects, Collagen, Shoulder, Tendons, Rotator cuff (Anatomy), Rotator cuff

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