1.

Diagnosis of PMR in the Patient:

 Patient presented with typical symptoms of PMR - pain and stiffness in shoulders
and hips, which are cardinal signs of PMR.
 2012 classification criteria suggest positive ultrasound findings with 66%
sensitivity and 81% specificity for diagnosing PMR.
 Raised inflammatory markers in this patient align with the required criteria for
diagnosing PMR.
2. Ultrasound Findings in PMR:
 Shoulder: sub-deltoid bursitis, biceps tenosynovitis, glenohumeral synovitis.
 Hip: hip synovitis, trochanteric bursitis.
3. Distinguishing PMR from Other Disorders:
 Absence of distal joint involvement, negative RF, and anti-CCP can exclude RA in
patients with PMR symptoms.
4. PMR and GCA:
 Approximately one-sixth of PMR patients can have GCA, with early
manifestations including headache, temporal artery tenderness, and visual loss.
 Imaging findings of GCA may reveal arterial wall edema and thickening,
detectable through FDG-PET, color Doppler sonography, MRI, and CT.
5. FDG-PET in GCA:
 FDG-PET is highly sensitive for ruling out large vessel vasculitis but lacks vessel
anatomy visualization and has drawbacks like high ionizing radiation and cost.
 Temporal artery biopsies may show less frequent positivity in patients with
plasma cell vasculitis.
6. Management of PMR and GCA:
 2015 EULAR and ACR recommendations guide the medical treatment for GCA.
References:
 Hellmich B, Agueda A, Monti S, et al. (2018). Update of the EULAR recommendations for
the management of large vessel vasculitis in Annals of the Rheumatic Diseases.
 Dejaco C, et al. (2015). Recommendations for the management of polymyalgia
rheumatica: a collaborative initiative between European League Against Rheumatism
and American College of Rheumatology in Ann Rheum Dis.
 2012 provisional classification criteria for polymyalgia rheumatica: a collaborative
initiative between European League Against Rheumatism and American College of
Rheumatology in Ann Rheum Dis.
 Dario Camellino and Marco A. Cimmino (2011). Imaging of polymyalgia rheumatica:
indications on its pathogenesis, diagnosis, and prognosis in Rheumatolog