DISTAL MUSCULOSKELETAL MANIFESTATIONS IN POLYMYALGIA-RHEUMATICA - A PROSPECTIVE FOLLOW-UP-STUDY

Objective. To determine the frequency and the characteristics of dista l musculoskeletal manifestations in polymyalgia rheumatica (PMR). Meth ods. Prospective followup study of 177 consecutive patients meeting cl inical criteria for PMR, diagnosed over a 5-year period in 2 rheumatol ogy secondary referral centers in Italy. Results. Seventy-nine of the 177 patients (45%) had distal musculoskeletal manifestations. Peripher al arthritis occurred in 45 patients (25%), carpal tunnel syndrome in 24 (14%), distal extremity swelling with pitting edema in 21 (12%), an d distal tenosynovitis in 5 (3%), These manifestations were usually as sociated,vith PMR proximal symptoms (69%); however, 31% of the episode s represented isolated relapse/recurrence at distal sites. Distal symp toms responded promptly to corticosteroids. No evidence of joint defor mities, erosions, or development of rheumatoid arthritis was observed during the followup. The group of patients with peripheral arthritis i ncluded a higher proportion of females, had a longer duration of thera py, and had more relapses/ recurrences, Patients who had distal extrem ity swelling with pitting edema had a higher age at disease onset, a s horter duration of therapy, and lower initial and cumulative prednison e doses. Conclusion. Inflammatory involvement of distal articular and/ or tenosynovial structures occurs in approximately half of the cases o f PMR, Peripheral arthritis is associated with more severe disease, wh ile distal extremity swelling with pitting edema appears to identify a more benign disease subset.