Treatment of polymyalgia rheumatica: a physiopathologic approach

Polymyalgia rheumatica is an inflammatory syndrome affecting older people and its prevalence has increased in recent years. The suppression of the hypothalamic–pituitary–adrenal axis and aging may contribute to the pathogenesis of polymyalgia rheumatica. Chronic stress (i.e., interpersonal stress, chronic infections and so on) in elderly people may represent a risk factor for the development of polymyalgia rheumatica. In fact, the elderly represent per se a condition of endocrine senescence including adrenal hypofuction. In addition, chronic stress represents a further harmful stimulus to seriously compromise endogenous glucocorticoid production. Synovitis and vasculitis characterize most patients. Serum cytokine and steroidal hormone patterns suggest that patients with polymyalgia rheumatica have an intensive inflammatory reaction. As a matter of fact, glucocorticoids represent the most useful temporary replacement treatment during the active phase of polymyalgia rheumatica. The use of slow-release gluco...