Materiały źródłowe

• #1 Polymyalgia Rheumatica – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK537274/

  The etiology of PMR is not well-understood. […] Familial aggregation of PMR has suggested a genetic predisposition. HLA class II alleles are found to be associated with PMR, and among these, the HLA-DRB1*04 allele correlates most frequently, seen in up to 67% of cases. […] There were reports of increased incidence of PMR along with GCA during epidemics of mycoplasma pneumonia and parvovirus B19 in Denmark, suggesting a possible role of infection in etiopathogenesis. […] The Epstein-Barr virus (EBV) has also been proposed as a possible trigger for PMR. […] However, several other studies have not supported an infectious etiology hypothesis. […] There are also reports of an association between PMR and diverticulitis, which could suggest a role of a change in microbiota and chronic bowel inflammation in the immunopathogenesis of the disease. […] A case series of previously healthy subjects developing GCA/PMR after influenza vaccination also exists. Vaccine adjuvants can trigger autoimmunity-causing autoimmune/inflammatory syndrome induced by adjuvants (ASIA), which can have clinical features similar to PMR.

• #2 Polymyalgia Rheumatica – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/vasculitis/polymyalgia-rheumatica

  Polymyalgia rheumatica is a syndrome closely associated with giant cell arteritis (temporal arteritis). […] Etiology and pathogenesis of polymyalgia rheumatica are unknown. […] Polymyalgia rheumatica may precede, follow, or occur simultaneously with giant cell arteritis. […] Ultrasound and MRI findings suggest that there is low-grade axial synovitis and bursitis.

• #3 Polymyalgia rheumatica – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/polymyalgia-rheumatica/symptoms-causes/syc-20376539

  Experts don’t know the cause of polymyalgia rheumatica. But genes may be part of the cause. Certain genes and gene changes might raise the risk of polymyalgia rheumatica. […] Researchers are studying other causes of the condition. […] Polymyalgia rheumatica and another condition known as giant cell arteritis are alike in many ways. Many people who have one of these conditions also have symptoms of the other.

• #4 Risk Factors and Possible Causes of Polymyalgia Rheumatica

  https://www.arthritis-health.com/types/polymyalgia-rheumatica/risk-factors-and-possible-causes-polymyalgia-rheumatica

  A specific gene called HLA-DR4 that is associated with rheumatoid arthritis is also present in many cases where PMR and giant cell arteritis occur together. Experts speculate this gene triggers the condition, although this is not a conclusive cause in PMR. […] Blood tests indicate immune system cells penetrating the synovial membrane of joints and tendons, resulting in inflammation. This is similar to the autoimmune process in which the body tissues are attacked by its own immune system. […] The sudden start of PMR and the nature of the symptoms like joint pain, fever, and malaise, are suspected to be a result of infections caused by viruses. […] Damage of superficial arteries by over exposure to ultra violet radiation from the sun is another proposed cause for the development of PMR. Some studies suggest the elastic fibers present in the arteries and synovial membranes are damaged by ultra violet rays. These damaged tissues may get infected by viruses that remain dormant for a long time and may get reactivated later, causing PMR. […] These same risk factors and possible causes are also seen in giant cell arteritis. Expert analysis indicates 40% to 60% of giant cell arteritis cases eventually develop PMR. There is also a 9% to 20% risk of PMR cases developing giant cell arteritis.

• #5 Polymyalgia Rheumatica | Arthritis Foundation

  https://www.arthritis.org/diseases/polymyalgia-rheumatica

  Polymyalgia rheumatica (PMR) is a form of inflammatory arthritis that mainly affects the shoulders, arms, hips and low back. […] Experts believe that many rheumatic diseases are triggered by something in the environment, such as a viral infection, in people who have certain genes that make them vulnerable. For example, the HLA-DR4 family of genes is associated with joint inflammation in rheumatoid arthritis (RA), and may be involved in some cases of PMR, but it seems to vary with different groups of people. […] Some factors believed to trigger PMR include a reaction to the seasonal flu vaccine and possibly to the COVID-19 vaccine, although the link with COVID vaccination is controversial. […] A stronger association seems to exist between PMR and diverticulitis inflammation in pouches that form in the large intestine, so it might have something to do with an imbalance in the microbiome, which is also linked to many other rheumatic diseases.

• #6 Patients’ views on the causes of their polymyalgia rheumatica: a content analysis of data from the PMR Cohort Study | BMJ Open

  https://bmjopen.bmj.com/content/7/1/e014301

  Polymyalgia rheumatica (PMR) is a common inflammatory disease of older adults, which is more prevalent in females than males and is predominantly found in the Caucasian community. PMR classically presents with a sudden onset of bilateral myalgia/pain in the shoulder and hip girdles as well as systemic features such as weight loss, nausea and fever. The aetiopathology of PMR is currently not well understood, although studies suggest genetic factors including human leucocyte antigen shared epitope and polymorphisms in proinflammatory cytokines such as tumour necrosis factor- and interleukin-6 cluster genes may be implicated. Infections and vaccinations (eg, influenza) have also been linked to slightly higher risk of developing PMR, although to date, these studies are inconclusive. […] […] This study has identified a wide variety of factors that respondents believe caused their PMR. Commonest proposed causes were injury, personal stress and the ageing process. While some respondents cited a single cause; others suggested multiple factors in the development of their condition. However, the majority of those in this cohort did not know what had caused their PMR. This study is the first to examine patient beliefs about the causes of PMR. […]

• #7 Polymyalgia Rheumatica (PMR): Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/330815-overview

  Polymyalgia rheumatica (PMR) is a relatively common chronic inflammatory condition of unknown etiology that affects elderly individuals. […] The exact cause (or causes) of polymyalgia rheumatica (PMR) is unknown. The disease is more common among northern Europeans, which may indicate a genetic predisposition. Other risk factors for PMR are an age of 50 years or older and the presence of GCA. […] An autoimmune process may play a role in PMR development. PMR is associated with the HLA-DR4 haplotype. A high level of IL-6 is associated with increased disease activity. […] Onset and recurrence of PMR has been reported shortly after viral infections (eg, influenza) and vaccinations, including COVID-19 vaccination. […] Falsetti et al noted that cases following apparent environmental triggers were characterized by higher CRP at diagnosis, faster response to therapy, and milder shoulder synovitis, suggesting that this may represent a different subset of PMR.

• #8 Risk Factors and Possible Causes of Polymyalgia Rheumatica

  https://www.arthritis-health.com/types/polymyalgia-rheumatica/risk-factors-and-possible-causes-polymyalgia-rheumatica

  Several risk factors are associated with polymyalgia rheumatica (PMR). These risk factors, as well the possible causes of PMR are described below. […] The risk of PMR is known to increase with age. The condition is rarely seen in people under 50 years of age. Most cases involve people 75 years and older. […] Women are approximately 2 to 3 times more likely to be affected by PMR than men. […] People of any ethnicity can develop PMR. However, Caucasian people of northern European descent appear to be at a significantly higher risk. […] Not everyone with these risk factors will develop PMR. The presence of these risk factors only increases the likelihood of developing PMR. […] Several potential causes for PMR are being investigated. Some of the theories put forward by researchers include:

• #9 Polymyalgia Rheumatica – Women’s Health – Associates for Women’s Medicine – Syracuse NY Gynecologist, Gynecology, Obstetrics, OBGYN, OB Physicians, Syracuse New York, Fayetteville, North Syracuse, LiverpoolPolymyalgia Rheumatica

  https://www.afwomensmed.com/health-library/hw-view.php?DOCHWID=tn6038

  Polymyalgia rheumatica (say „pah-lee-my-AL-juh roo-MAT-ih-kuh”), or PMR, is a condition that causes inflammation of the joints. This causes pain and stiffness, most often in the neck, shoulders, or hips. […] Experts don’t fully understand what causes PMR. It may be that the immune system is attacking the body’s own tissues. Your genes may play a role in this. For example, people whose ancestors came from Scandinavia or Northern Europe are more likely to have this problem. […] PMR occurs in women more often than in men. It is more common as people get older.

• #10 Polymyalgia rheumatica – Wikipedia

  https://en.wikipedia.org/wiki/Polymyalgia_rheumatica

  Polymyalgia rheumatica (PMR) is a systemic inflammatory disease characterized by pain or stiffness, usually in the neck, shoulders, upper arms, and hips, but which may occur all over the body. […] The exact cause of PMR, including whether or not it may be an autoimmune disease, is unclear. […] The pathophysiology of polymyalgia rheumatica is not well-understood. Evidence shows that there is likely a combined genetic and environmental pathophysiology behind the disease, but concrete identification of the causes, including whether or not polymyalgia rheumatica is an autoimmune disease, remains elusive. […] It is, at the very least, an immune-mediated disease, with both innate and adaptive immune system elements being known to play a role. […] Infectious diseases have historically been hypothesized as a likely trigger for disease in genetically susceptible people.

• #11 Polymyalgia Rheumatica: A Severe, Self-Limiting Disease

  https://www.uspharmacist.com/article/polymyalgia-rheumatica-a-severe-self-limiting-disease

  The cause of PMR is unknown. PMR is closely linked to GCA, although the two are believed to be separate disease processes. […] One hypothesis is that in a genetically predisposed patient, an environmental factor, possibly a virus, causes monocyte activation, which helps the production of the cytokines that induce PMR and GCA. The prevalence of antibodies to adenovirus and respiratory syncytial virus is reportedly higher in patients with PMR. Increased occurrence in siblings suggests a genetic role in the pathophysiology of the disease. […] An autoimmune process may play a role in PMR development.

• #12 Polymyalgia Rheumatica | Comprehensive Rheumatology

  https://www.comprehensiverheumatology.com/index.html@p=355.html

  Polymyalgia Rheumatica (PMR) is a relatively common inflammatory condition that causes aching pain and stiffness in the shoulders, hips, neck, and back. […] The exact cause of the PMR is unknown, though it is believed to have a genetic factor to it. Environmental and infectious causes were studied, but have been inconclusive. […] The condition is associated with the HLA-DR4 haplotype. A high level of IL-6 (a pro-inflammatory cytokine) has also been associated with this condition.

• #13 Polymyalgia rheumatica: pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4954311/

  Polymyalgia rheumatica (PMR) is an inflammatory musculoskeletal disorder, with a lifetime risk of 2.4% for women and 1.7% for men. Its cause is unknown, but ultrasound and magnetic resonance imaging (MRI) studies reveal extra-capsular inflammation, such as bursitis, in addition to synovitis. PMR classically responds very well to systemic glucocorticoids. […] By far the strongest risk factor for PMR is increasing age. PMR is virtually unheard of in those under 50 years old and incidence of the disease becomes more common with each decade, with a peak incidence around 75 years. The reason for this is unclear. Ageing of the immune system (immunosenescence), ageing of the tissues and ageing of neurohumoral regulatory systems may all be involved. Based on the clustering of cases in space and time, it has been proposed that PMR may be triggered by infection in some cases. This could lead to persistent inflammation on a background of chronic low-grade inflammation secondary to decline in adaptive immunity and a compensatory increase in innate immune mechanisms. Neurohumoral mechanisms may also be involved.

• #14 Risk Factors and Possible Causes of Polymyalgia Rheumatica

  https://www.arthritis-health.com/types/polymyalgia-rheumatica/risk-factors-and-possible-causes-polymyalgia-rheumatica

  A specific gene called HLA-DR4 that is associated with rheumatoid arthritis is also present in many cases where PMR and giant cell arteritis occur together. Experts speculate this gene triggers the condition, although this is not a conclusive cause in PMR. […] Blood tests indicate immune system cells penetrating the synovial membrane of joints and tendons, resulting in inflammation. This is similar to the autoimmune process in which the body tissues are attacked by its own immune system. […] The sudden start of PMR and the nature of the symptoms like joint pain, fever, and malaise, are suspected to be a result of infections caused by viruses. […] Damage of superficial arteries by over exposure to ultra violet radiation from the sun is another proposed cause for the development of PMR. Some studies suggest the elastic fibers present in the arteries and synovial membranes are damaged by ultra violet rays. These damaged tissues may get infected by viruses that remain dormant for a long time and may get reactivated later, causing PMR. […] These same risk factors and possible causes are also seen in giant cell arteritis. Expert analysis indicates 40% to 60% of giant cell arteritis cases eventually develop PMR. There is also a 9% to 20% risk of PMR cases developing giant cell arteritis.

• #15 Polymyalgia rheumatica – Wikipedia

  https://en.wikipedia.org/wiki/Polymyalgia_rheumatica

  Proposed causative pathogens, none of which have been proven, include: Mycoplasma pneumoniae, Chlamydia pneumoniae, Hepatitis B virus (HBV), Parvovirus B19, Adenovirus (ADV), Respiratory syncytial virus (RSV). […] Persons having the HLA-DR4 type of human leucocyte antigen appear to have a higher risk of PMR.

• #16 Polymyalgia Rheumatica – Vasculitis Foundation

  https://vasculitisfoundation.org/education/vasculitis-types/polymyalgia-rheumatica/

  Polymyalgia rheumatica (PMR) is a rare inflammatory disease that affects older adults, causing widespread muscle pain and stiffness, especially around the shoulders and hips. Most people who develop PMR are in their 60s or 70s. PMR is closely linked with giant cell arteritis (GCA), a type of vasculitis characterized by inflammation of the arteries in the head (temples) and of the aorta, resulting in headaches and vision problems. Left untreated, GCA can lead to blindness and stroke. The two diseases can occur at the same time in the same person. Approximately 15 percent to 20 percent of people with PMR will develop GCA, while about half of patients with GCA also have symptoms of PMR. […] The exact cause of PMR is unknown. Like vasculitis, it is classified as an autoimmune disorder—a disease that occurs when the body’s natural defense system mistakenly attacks healthy tissue. Researchers believe genetics and environmental factors may play a role in the onset of PMR. Rarely, the disease occurs in an individual who has cancer. New cases of PMR often occur seasonally, suggesting that a virus may play a role in triggering the disease.

• #17 Polymyalgia Rheumatica: Symptoms, Tests, and Treatment

  https://www.healthline.com/health/polymyalgia-rheumatica

  Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness in various parts of the body. […] The cause of polymyalgia rheumatica isnt known. However, its believed that certain genes and gene variations may increase your risk for developing it. […] Environmental factors may also play a role in the development of the condition. New cases of polymyalgia rheumatic are often diagnosed in cycles and usually occur seasonally. […] This suggests that there may be an environmental trigger, such as a viral infection, that causes the condition. The rapid onset of symptoms also suggests that polymyalgia rheumatica may be triggered by an infection. However, no such link has been found.

• #18 Polymyalgia rheumatica | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/polymyalgia-rheumatica-is-your-muscle-stiffness-age-or-immuno-related

  Polymyalgia rheumatica is an inflammatory disorder that causes pain and stiffness in the muscles around the neck, shoulders, pelvis, hips and upper legs. Generally, it presents as an autoimmune disease that is triggered by one of several stimuli in the environment. […] While the cause of polymyalgia rheumatica is unknown, it is believed that the disorder develops due to a combination of genetic and environmental factors. […] Infections, traumatic injuries or sudden shocks such as bereavement or a period of high stress can trigger the onset of polymyalgia rheumatica. There have now been reported cases of polymyalgia rheumatica occurring after a COVID-19 infection or, in some cases, after a COVID-19 vaccination. Despite this, polymyalgia rheumatica will usually arise without a clear trigger being identifiable.

• #19

  https://www.nhs.uk/conditions/polymyalgia-rheumatica/

  The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible. […] Polymyalgia rheumatica is an age-related condition. Most people diagnosed with it are over 65, and it’s very rare in people younger than 50. It’s also more common in women than men.

• #20 Polymyalgia Rheumatica: Understanding the Signs and Symptoms

  https://creakyjoints.org/polymyalgia-rheumatica/polymyalgia-rheumatica-symptoms/

  Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes severe pain and stiffness that can come on suddenly, in a few days or even overnight. […] While there is no known cause of the disease, studies of patients with PMR have shown the appearance of inflammation in the connective tissue around joints (synovium), particularly around the shoulders and hips. […] What triggers the inflammation is uncertain, although a gradual dysfunction of the immune system that happens with aging (immunosenescence) is thought to be an important part of the disease and may explain why this condition almost exclusively affects people over age 50, says Dr. Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. […] Additionally, some researchers think that certain types of white blood cells may trigger the inflammation of PMR, according to a 2023 review in Frontiers in Medicine. […] Dr. George adds that studies have shown high levels of the inflammatory protein called interleukin 6 (IL-6) in the blood of patients with PMR.

• #21 Polymyalgia rheumatica: pathogenesis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4954311/

  The subset of PMR patients that later develop GCA tend to have higher inflammatory markers and particular HLA-DRB1 alleles (a subclass of the human leukocyte antigen [HLA]) and so receive a higher than usual dose of glucocorticoids at PMR onset. Indeed, studies of GCA consistently reveal an association with HLA-DRB1*04 alleles, whereas no consistent HLA association of PMR has been found. At present PMR may be best viewed as a clinical syndrome with heterogeneous aetiology, overlapping with GCA in only a minority of cases.

• #22 What Is the Cause of Polymyalgia Rheumatica?

  https://advancedrheum.com/what-is-the-cause-of-polymyalgia-rheumatica/

  What Is the Cause of Polymyalgia Rheumatica? […] However, there is no one answer because researchers are unsure of its exact cause. […] There are several theories as to what may cause PMR, but scientists believe the following could be contributing factors: […] Some individuals, particularly those with a family history of autoimmune disorders, may be genetically predisposed to PMR. […] Exposure to specific pathogens or toxins may contribute to the development of PMR. […] Viral infections, such as respiratory, might trigger PMR in susceptible individuals. […] Some studies suggest hormonal imbalances, especially the changes in hormone levels associated with aging, may be a factor in the development of PMR. […] Stress may not directly cause PMR, but it could exacerbate its symptoms.

• #23 Patients’ views on the causes of their polymyalgia rheumatica: a content analysis of data from the PMR Cohort Study | BMJ Open

  https://bmjopen.bmj.com/content/7/1/e014301

  Thus, to date, although the cause of PMR is not known, patients with PMR reported a range of factors which they believe to have caused their illness. Commonly cited causes included injury, personal stress, ageing, medication and chronic illness. Engaging in dialogue with patients to understand their illness beliefs may help patients to make sense of their illness and influence coping and self-management strategies and thus have a positive impact on the clinical management of PMR.

• #24 Patients’ views on the causes of their polymyalgia rheumatica: a content analysis of data from the PMR Cohort Study | BMJ Open

  https://bmjopen.bmj.com/content/7/1/e014301

  Polymyalgia rheumatica (PMR) is a common inflammatory disease of older adults, which is more prevalent in females than males and is predominantly found in the Caucasian community. PMR classically presents with a sudden onset of bilateral myalgia/pain in the shoulder and hip girdles as well as systemic features such as weight loss, nausea and fever. The aetiopathology of PMR is currently not well understood, although studies suggest genetic factors including human leucocyte antigen shared epitope and polymorphisms in proinflammatory cytokines such as tumour necrosis factor- and interleukin-6 cluster genes may be implicated. Infections and vaccinations (eg, influenza) have also been linked to slightly higher risk of developing PMR, although to date, these studies are inconclusive. […] […] This study has identified a wide variety of factors that respondents believe caused their PMR. Commonest proposed causes were injury, personal stress and the ageing process. While some respondents cited a single cause; others suggested multiple factors in the development of their condition. However, the majority of those in this cohort did not know what had caused their PMR. This study is the first to examine patient beliefs about the causes of PMR. […]

• #25 Polymyalgia Rheumatica | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/polymyalgia-rheumatica/

  Polymyalgia rheumatica is an inflammatory disorder that causes muscle pain and stiffness, particularly in the shoulders and hips. The condition develops most often in people ages 65 and older, and it might be related to another inflammatory disorder known as giant cell arteritis. […] Medical experts have not yet found the exact cause of polymyalgia rheumatica, but they have found that two factors are involved: […] Certain genes or gene variations might increase the risk of polymyalgia rheumatica. […] Environmental factors, perhaps exposure to a virus, might trigger the disease.

• #26 The facts about Polymyalgia Rheumatica.

  https://www.gbhealthwatch.com/polymyalgiarheumatica-details.php

  This booklet contains general information about polymyalgia rheumatica and giant cell arteritis. It describes what they are, their causes, and treatment options. Highlights of research are also included. […] The cause of polymyalgia rheumatica is not known. But it is associated with immune system problems, genetic factors, and an event, such as an infection, that triggers symptoms. The fact that polymyalgia rheumatica is rare in people under the age of 50 and becomes more common as age increases, suggests that it may be linked to the aging process. […] Researchers studying possible causes of polymyalgia rheumatica and giant cell arteritis are investigating the role of genetic predisposition, immune system problems, and environmental factors.

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