Instead of increasing the woman’s prednisolone dosage, the researchers started the woman on repaglinide therapy that was later switched to mitiglinide to improve her glycemic control. During the next two weeks, her symptoms improved.
The third case involved a 73-year-old man with bilateral shoulder and upper-arm pain, morning stiffness, and bilateral hip pain. The man, who fulfilled the criteria for PMR, had been using NSAIDs for five months without benefit. At that point, his labs showed a CRP level of 28 mg/L, and an HbA1c concentration of 6.7%. The researchers treated him with mitiglinide and pioglitazone. His glycemic control improved during the next two weeks, as did his symptoms and laboratory findings.
Dr. Yoshida did not respond to a request for comments.
While PMR is the second most common inflammatory autoimmune condition that affects the elderly, it’s possible that one or two of the three patients might have something else, says Ashina Makol, MD, an assistant professor in the division of rheumatology at the Mayo Clinic, Rochester, Minn. There are other disorders that could produce the same symptoms, she added.
Two of the three patients are in their 70s, which is the age at which the condition usually appears, Dr. Makol says. However, the most telling sign that a patient’s symptoms are caused by PMR is a response to steroids and two of the patients described in the paper never got steroids.
And while the authors say that the patients fulfill the 2012 EULAR/ACR provisional criteria for PMR, those criteria were not developed as a diagnostic aid, but rather to assure that there would be homogenous groups of patients in clinical trials, Dr. Makol says.
Dr. Makol would like to see long-term follow-up on the three patients and would welcome a clinical trial, but, she says, “I don’t know whether it would be feasible to do. Would one arm of the study not receive any treatment?”
Sidebar: The Rheumatologist asked Eric Matteson, MD, professor emeritus of rheumatology, Mayo Clinic, Rochester, Minn, to comment on this case series.
“So far, no studies have demonstrated an increased risk of developing PMR in patients who have diabetes, nor are there any studies that consistently demonstrate a risk of developing diabetes in patients with PMR,” Dr. Matteson says. “I think if there were a true link, we would have uncovered it. As Dr. Makol points out, the preliminary classification criteria for PMR are for not intended for diagnosis and require competing conditions be ruled out. Here, we cannot be certain about underlying disease in the non-glucocorticoid exposed patients, and the glucocorticoid exposed patient apparently was already diagnosed and under treatment for PMR.
