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Aktuelle Rheumatologie 2014; 39(04): 227-231
DOI: 10.1055/s-0034-1374607
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Differenzialdiagnose der Polymyalgia rheumatica (PMR) und der Riesenzell-Arteriitis (RZA)

Differential Diagnosis of Polymyalgia Rheumatica and Giant Cell Arteritis
G. Keyßer
1   Abteilung für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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Publication History

Publication Date:
15 August 2014 (online)

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Zusammenfassung

Die Differenzialdiagnose der Polymyalgia rheumatica (PMR) und der Riesenzellarteriitis (RZA) ist vielfältig. Da beide Entitäten das höhere Lebensalter betreffen, sind verschleißbedingte Symptome des Schultergürtels, aber auch projizierte Schmerzen bei chronisch-ischämischer Herzkrankheit sowie Tumorerkrankungen in die differenzialdiagnostischen Überlegungen einzubeziehen. Auch die Inzidenz neurologisch-psychiatrischer Krankheiten wie der M. Parkinson oder Depressionen – beide sind als Ursachen chronischer Schmerzen bekannt – steigt altersbedingt an. Medikamenten-Nebenwirkungen können ebenso Auslöser von Myalgien sein wie (v. a. virale) Infektionen. Bei letzteren steigen zusätzlich die Akut-Phase-Parameter an, sodass Virusinfekte zu PMR-ähnlichen Konstellationen führen können.

Abstract

Both polymyalgia rheumatica and giant cell arteritis possess a multifaceted differential diagnosis. Since both entities are typical diseases of the elderly, degenerative disorders of the musculoskeletal system as well as ischemic heart disease and malignancies have to be taken into account. The incidence of neuropsychiatric diagnoses such as Parkinson’s disease and depression is rising with age as well. Both conditions are known to cause chronic and widespread musculoskeletal pain. Drug induced side effects can mimic polymyalgia rheumatica as well as infections, the latter also leading to increased acute phase parameters.··

Schlüsselwörter

Polymyalgia rheumatica - Arteriitis temporalis - Riesenzellarteriitis - Differentialdiagnose

Key words

polymyalgia rheumatica - temporal arteritis - giant cell arteritis - differential diagnosis
 

  • Literatur

  • 1 Davis MP, Srivastava M. Demographics, assessment and management of pain in the elderly. Drugs & aging 2003; 20: 23-57
    CrossrefPubMedGoogle Scholar
  • 2 Ferrell BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. Journal of pain and symptom management 1995; 10: 591-598
    CrossrefPubMedGoogle Scholar
  • 3 van Schaardenburg D, Van den Brande KJ, Ligthart GJ et al. Musculoskeletal disorders and disability in persons aged 85 and over: a community survey. Annals of the rheumatic diseases 1994; 53: 807-811
    CrossrefPubMedGoogle Scholar
  • 4 Chard MD, Hazleman BL. Shoulder disorders in the elderly (a hospital study). Annals of the rheumatic diseases 1987; 46: 684-687
    CrossrefPubMedGoogle Scholar
  • 5 van Schaardenburg D, Breedveld FC. Elderly-onset rheumatoid arthritis. Semin Arthritis Rheum 1994; 23: 367-378
    CrossrefPubMedGoogle Scholar
  • 6 Frediani B, Falsetti P, Storri L et al. Evidence for synovitis in active polymyalgia rheumatica: sonographic study in a large series of patients. The Journal of rheumatology 2002; 29: 123-130
    PubMedGoogle Scholar
  • 7 Healey LA. Polymyalgia rheumatica is the result of synovitis. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases 2006; 12: 165-166
    CrossrefPubMedGoogle Scholar
  • 8 van Schaardenburg D. Rheumatoid arthritis in the elderly. Prevalence and optimal management. Drugs & aging 1995; 7: 30-37
    CrossrefPubMedGoogle Scholar
  • 9 Halverson PB, Carrera GF, McCarty DJ. Milwaukee shoulder syndrome. Fifteen additional cases and a description of contributing factors. Archives of internal medicine 1990; 150: 677-682
    CrossrefPubMedGoogle Scholar
  • 10 Aouba A, Vuillemin-Bodaghi V, Mutschler C et al. Crowned dens syndrome misdiagnosed as polymyalgia rheumatica, giant cell arteritis, meningitis or spondylitis: an analysis of eight cases. Rheumatology (Oxford) 2004; 43: 1508-1512
    CrossrefPubMedGoogle Scholar
  • 11 Toussirot E, Wendling D. Late-onset ankylosing spondylitis and related spondylarthropathies: clinical and radiological characteristics and pharmacological treatment options. Drugs & aging 2005; 22: 451-469
    CrossrefPubMedGoogle Scholar
  • 12 Arnaud L, Mathian A, Boddaert J et al. Late-onset systemic lupus erythematosus: epidemiology, diagnosis and treatment. Drugs & aging 2012; 29: 181-189
    CrossrefPubMedGoogle Scholar
  • 13 Keyßer G. Die Schulter bei internistischen Erkrankungen. Aktuelle Rheumatologie 2011; 36: 123-128
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Haga HJ, Eide GE, Brun J et al. Cancer in association with polymyalgia rheumatica and temporal arteritis. The Journal of rheumatology 1993; 20: 1335-1339
    PubMedGoogle Scholar
  • 15 Kohli M, Bennett RM. An association of polymyalgia rheumatica with myelodysplastic syndromes. The Journal of rheumatology 1994; 21: 1357-1359
    PubMedGoogle Scholar
  • 16 Enright H, Jacob HS, Vercellotti G et al. Paraneoplastic autoimmune phenomena in patients with myelodysplastic syndromes: response to immunosuppressive therapy. British journal of haematology 1995; 91: 403-408
    CrossrefPubMedGoogle Scholar
  • 17 Hamidou MA, Boumalassa A, Larroche C et al. Systemic medium-sized vessel vasculitis associated with chronic myelomonocytic leukemia. Semin Arthritis Rheum 2001; 31: 119-126
    CrossrefPubMedGoogle Scholar
  • 18 Fautrel B, Fermand JP, Sibilia J et al. Amyloid arthropathy in the course of multiple myeloma. The Journal of rheumatology 2002; 29: 1473-1481
    PubMedGoogle Scholar
  • 19 Feun LG, Raub Jr WA, Duncan RC et al. Melanoma in a southeastern Hispanic population. Cancer detection and prevention 1994; 18: 145-152
    PubMedGoogle Scholar
  • 20 Bakheet SM, Hammami MM. Spurious thyroid cancer bone metastases on radioiodine scan due to external contamination. European journal of radiology 1993; 16: 239-242
    CrossrefPubMedGoogle Scholar
  • 21 Jacobsen KD, Folleras G, Fossa SD. Metastases from renal cell carcinoma to the humerus or the shoulder girdle. British journal of urology 1994; 73: 124-128
    CrossrefPubMedGoogle Scholar
  • 22 Horne R, James D, Petrie K et al. Patients’ interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart 2000; 83: 388-393
    CrossrefPubMedGoogle Scholar
  • 23 D’Antono B, Dupuis G, Fleet R et al. Sex differences in chest pain and prediction of exercise-induced ischemia. The Canadian journal of cardiology 2003; 19: 515-522
    PubMedGoogle Scholar
  • 24 Kosuge M, Kimura K, Ishikawa T et al. Differences between men and women in terms of clinical features of ST-segment elevation acute myocardial infarction. Circulation journal: official journal of the Japanese Circulation Society 2006; 70: 222-226
    CrossrefPubMedGoogle Scholar
  • 25 Swap CJ, Nagurney JT. Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes. JAMA: the journal of the American Medical Association 2005; 294: 2623-2629
    CrossrefPubMedGoogle Scholar
  • 26 Lovlien M, Schei B, Hole T. Women with myocardial infarction are less likely than men to experience chest symptoms. Scandinavian cardiovascular journal: SCJ 2006; 40: 342-347
    CrossrefPubMedGoogle Scholar
  • 27 Lovlien M, Johansson I, Hole T et al. Early warning signs of an acute myocardial infarction and their influence on symptoms during the acute phase, with comparisons by gender. Gender medicine 2009; 6: 444-453
    CrossrefPubMedGoogle Scholar
  • 28 McLean DE. Medical complications experienced by a cohort of stroke survivors during inpatient, tertiary-level stroke rehabilitation. Archives of physical medicine and rehabilitation 2004; 85: 466-469
    CrossrefPubMedGoogle Scholar
  • 29 Yamamoto S, Kazama JJ, Maruyama H et al. Patients undergoing dialysis therapy for 30 years or more survive with serious osteoarticular disorders. Clinical nephrology 2008; 70: 496-502
    CrossrefPubMedGoogle Scholar
  • 30 Chambers ST, Town GI, Neill AM et al. Legionella, Chlamydia pneumoniae and Mycoplasma infection in patients admitted to Christchurch Hospital with pneumonia. The New Zealand medical journal 1999; 112: 222-224
    PubMedGoogle Scholar
  • 31 Cunha BA, Hamid N, Krol V et al. Fever of unknown origin due to preleukemia/myelodysplastic syndrome: the diagnostic importance of monocytosis with elevated serum ferritin levels. Heart & lung: the journal of critical care 2006; 35: 277-282
    CrossrefPubMedGoogle Scholar
  • 32 Auzary C, Le Thi Huong D, Delarbre X et al. Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis. Clinical and experimental rheumatology 2006; 24: S38-S40
    PubMedGoogle Scholar
  • 33 Miyazaki M, Yoshiiwa T, Kodera R et al. Clinical features of cervical pyogenic spondylitis and intraspinal abscess. Journal of spinal disorders & techniques 2011; 24: E57-E61
    CrossrefPubMedGoogle Scholar
  • 34 Hadadi A, Rasoulinejad M, Khashayar P et al. Osteoarticular tuberculosis in Tehran, Iran: a 2-year study. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2010; 16: 1270-1273
    CrossrefPubMedGoogle Scholar
  • 35 Kapukaya A, Subasi M, Bukte Y et al. Tuberculosis of the shoulder joint. Joint, bone, spine: revue du rhumatisme 2006; 73: 177-181
    CrossrefPubMedGoogle Scholar
  • 36 De Ponti A, Vigano MG, Taverna E et al. Adhesive capsulitis of the shoulder in human immunodeficiency virus-positive patients during highly active antiretroviral therapy. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons [et al.] 2006; 15: 188-190
    PubMedGoogle Scholar
  • 37 Wirtz G, Federici L, Andres E. Cytomegalovirus infection in an immunocompetent patient complicated with pulmonary embolism and mimicking giant cell arteritis associated with polymyalgia rheumatica. Medecine et maladies infectieuses 2008; 38: 287-289 248
    CrossrefPubMedGoogle Scholar
  • 38 Genereau T, Martin A, Lortholary O et al. Temporal arteritis symptoms in a patient with hepatitis C virus associated type II cryoglobulinemia and small vessel vasculitis. The Journal of rheumatology 1998; 25: 183-185
    PubMedGoogle Scholar
  • 39 Al-Abdulla NA, Rismondo V, Minkowski JS et al. Herpes zoster vasculitis presenting as giant cell arteritis with bilateral internuclear ophthalmoplegia. American journal of ophthalmology 2002; 134: 912-914
    CrossrefPubMedGoogle Scholar
  • 40 Kosa SC, Younge BR, Kumar N. Headaches due to giant cell arteritis following herpes zoster ophthalmicus in an elderly patient. Cephalalgia: an international journal of headache 2010; 30: 239-241
    PubMedGoogle Scholar
  • 41 Soriano A, Verrecchia E, Marinaro A et al. Giant cell arteritis and polymyalgia rheumatica after influenza vaccination: report of 10 cases and review of the literature. Lupus 2012; 21: 153-157
    CrossrefPubMedGoogle Scholar
  • 42 Borsook D. Neurological diseases and pain. Brain: a journal of neurology 2012; 135: 320-344
    CrossrefPubMedGoogle Scholar
  • 43 Wasner G, Deuschl G. Pains in Parkinson disease – many syndromes under one umbrella. Nature reviews Neurology 2012; 8: 284-294
    PubMedGoogle Scholar
  • 44 Vaith P, Warnatz K. Clinical and serological findings of giant-cell arteritis. Zeitschrift für Rheumatologie 2009; 68: 124-131
    CrossrefPubMedGoogle Scholar
  • 45 Corruble E, Guelfi JD. Pain complaints in depressed inpatients. Psychopathology 2000; 33: 307-309
    CrossrefPubMedGoogle Scholar
  • 46 Abd TT, Jacobson TA. Statin-induced myopathy: a review and update. Expert opinion on drug safety 2011; 10: 373-387
    CrossrefPubMedGoogle Scholar
  • 47 Mor A, Wortmann RL, Mitnick HJ et al. Drugs causing muscle disease. Rheumatic diseases clinics of North America 2011; 37: 219-231
    CrossrefPubMedGoogle Scholar
  • 48 Mastaglia FL. Iatrogenic myopathies. Current opinion in neurology 2010; 23: 445-449
    CrossrefPubMedGoogle Scholar
  • 49 Mammen AL, Amato AA. Statin myopathy: a review of recent progress. Current opinion in rheumatology 2010; 22: 644-650
    CrossrefPubMedGoogle Scholar