Polymyalgia rheumatica

 

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Zusammenfassung

Mittels Ultraschall, MRT oder PET-CT lassen sich zusätzlich typische entzündliche Veränderungen im Schulter- und Beckengürtelbereich nachweisen, mittels MRT und PET-CT sogar paravertebral. Neue Klassifikationskriterien beinhalten Alter ≥ 50 Jahre, CRP- und / oder BSG-Erhöhung, Schultergürtelschmerz sowie zwei Algorithmen mit oder ohne Ultraschall. Letzter Algorithmus hat eine höhere Spezifität bei gleicher Sensitivität. Entsprechend neuen Therapieempfehlungen soll die Diagnose möglichst definitiv gestellt werden. Basis -Laboruntersuchungen und Komorbiditäten müssen berücksichtigt werden. Zunächst wird 12,5–25 mg / d Prednisonäquivalent verordnet und dann die Dosis auf 10 mg / d innerhalb von 4–8 Wochen reduziert, gefolgt von einer 4-wöchentlichen Reduktion um je 1 mg. Bei Risiken und Begleiterkrankungen kann zusätzlich Methotrexat verordnet werden. Verlaufskontrollen sollen innerhalb des 1. Jahres alle 4–8 Wochen erfolgen.

Abstract

Ultrasound, MRI and PET-CT reveal a typical anatomical distribution of inflammation in the shoulder and pelvic girdle. MRI and PET-CT may additionally show inflammation along the spine. New classification criteria include age ≥ 50 years, elevated CRP and / or ESR, and shoulder girdle pain as well as two alternative algorithms with or without ultrasound. The algorithm with ultrasound is more specific but equally sensitive than the other algorithm. According to new recommendations on management diagnosis should be definitely established. Lab tests need to be considered as well as comorbidities. A starting dose of 12.5–25 mg / d prednisone – equivalent is recommended, followed by a dose reduction to 10 mg / d within 4–8 weeks. Afterwards the dose should be reduced by 1 mg every 4 weeks. Methotrexate might be added in patients with significant risks and comorbidities. Follow-up visits should occur every 4–8 weeks during the first year.

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