Annals On Call - Polymyalgia Rheumatica and Giant Cell Arteritis
Authors: Robert M. Centor, Sebastian E. Sattui Cortes
Journal: Annals of Internal Medicine (2021)

Web ExclusivesJanuary 2021Annals On Call - Polymyalgia Rheumatica and Giant Cell ArteritisFREERobert M. Centor, MD, Sebastian E. Sattui Cortes, MDRobert M. Centor, MDHuntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.), Sebastian E. Sattui Cortes, MDHospital for Special Surgery, New York, New York (S.E.S.)Author, Article and Disclosure Informationhttps://doi.org/10.7326/A20-0004 CME/MOC SectionsAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this episode of Annals On Call, Dr. Centor discusses polymyalgia rheumatica and giant cell arteritis with Dr. Sebastian E. Sattui Cortes.Annals articles discussed include...In the Clinic: Polymyalgia Rheumatica: https://www.acpjournals.org/doi/full/10.7326/AITC201705020In the Clinic: Giant cell Arteritis: https://www.acpjournals.org/doi/full/10.7326/AITC201611010Improvement in Polymyalgia Rheumatica Associated With Improved Control of Diabetes Mellitus: A Case Series: https://www.acpjournals.org/doi/10.7326/L20-0196About Annals On CallAnnals On Call focuses on a clinically influential article published in Annals of Internal Medicine. Dr. Robert Centor shares his own perspective on the material and interviews topic area experts to discuss, debate, and share diverse insights about patient care and health care delivery.For more information on Annals On Call and for more episodes, visit go.annals.org/OnCall. Comments0 CommentsSign In to Submit A Comment Sergio StagnaroQuantum Biophysical Semeiotic Research Laboratory10 January 2021 Clincal Diagnoss of Polymyalgia Rheumatica both classical and acute benign variant. The clinical diagnosis of rheumatic polymyalgia is easily made on the basis of numerous and characteristic signs, bedside detected with the Quantum Biophysical Semeiotic, starting from its initial stage (1-2). Furthermore, with the help of this fundamental diagnostic method, I've discovered and described, for the first time, the acute benign variant of polymyalgia rheumatica, brought about by flu viruses in individuals positive to Rheumatic Constitution (4, 5). There are symptoms in common and differences between the Acute Benine Variante PR and the classical P.R. The following phenomena are in common: The mitochondrial impairment, heritable through the mother, i.e. CAEMH, is always present in both forms. In other words, the patients show, from birth, an intense impairment of mitochondrial activity, of terminal metabolism, that is, of oxidative phosphorylation with slowing of the flow of electrons in the respiratory chain and, therefore, reduction of the phosphorylated substrates rich in energy cells. The CAEMH is the sine qua non of immune-based diseases, suggesting a close relationship between HLA and CAEMH. The female sex is affected by preference: 60 out of 67 cases observed were women (90%); the sterno-clavicular and manubrium-sternal body synchondrosis are typically involved: no other disease affects these structures except for ankylosing spondylitis. The fact further suggests the possible existence of a relationship between HLA and CAEMH. In both forms of P.R. large proximal joints are affected exclusively or preferably; it is possible to observe (personal experience) classical P.R. in parents of patients with P.R.A.B.V. In one woman, the classic form appeared after 7 years. from the healing of a variant benign acute form. For obvious reasons, nothing conclusive can be reported on this interesting topic: the nature of both forms is clearly immune. These six facts allow us to define the acute benign variant form as "polymyalgia". These are the differences between the forms of P.R., some points must be considered: age of patients: the classic form is known to affect women (and men) over 60 years old. of age. On the contrary, the P.R.A.B.V. involves especially women under 55 years old. In the personal case series 50 times there are patients in this age, equal to 75%. In the opinion of the writer, however widely shared, the age factor gives particular characteristics to clinical phenomenology, although in the presence of identical etiological agents and of the same constitutional substrate - HLA or CAEMH. Although the large proximal, "rhizomelic" joints are most intensely affected, the distal ones also show p.asc signs. of suffering, of decreasing intensity towards the periphery. The cause of the acute benign variant forms is certainly viral: the viral influenza episode always precedes the onset of P.R. acute (3). Studies following the writing of the paper have shown that autoimmune diseases, including P.R.A.B.V., affect only individuals carrying CAEMH, characterized by right brain dominance (2). The etiology of P.R. classical is still uncertain even if there is insistence on viruses, in particular, HBV, as already mentioned. The clinical picture of the form described here is dominated by chest pain, localized, unilateral and by the consequent anxiety of the P. The therapy of the two forms is different: while cortisone drugs are the therapy of choice of P.R. classical, the acute form begnina variant reaches complete recovery, in ca. 10 days, under anti-catarrhal vaccine treatment and with metisoprinol. References 1) Stagnaro S., Auscultatory Percussion of Rheumatic Diseases. X European Congress of Rheumatology. Moscow. 26 June-July, 1983. Proceedings, pg 175. 2) Stagnaro S., Auscultatory Percussion Therapeutic Monitoring and Cerebral Dominance in Rheumatology. 2nd World Congress of Inflammation, Antirheumatics, analgesics, immunomodulators. Abstracts, A. Book 1, pg. 116, March 19-22, 1986, Montecarlo. 3) Stagnaro S., Polimialgia Reumatica Acuta Benigna Variante. Clin. Ter. 118, 193, 1986 [Medline] . 4) Stagnaro-Neri M., Stagnaro S. Introduzione alla Semeiotica Biofisica. Il Terreno Oncologico. Travel Factory, Roma, 2004. http://www.travelfactory.it/semeiotica_biofisica.htm 5) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/libro_costituzionisemeiotiche.htm Disclosures: Conflict of interest not declared Author, Article and Disclosure InformationAffiliations: Huntsville Regional Medical Campus, University of Alabama Birmingham School of Medicine, Birmingham, Alabama (R.M.C.)Hospital for Special Surgery, New York, New York (S.E.S.)Disclosures: Dr. Centor has disclosed the following: Consultancy: DynaMed, MDCalc, Medscape, National Kidney Foundation, The Curbsiders. Employment: U.S. Department of Veterans Affairs. Dr. Sattui Cortes has disclosed no conflicts of interest.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.This article was published at Annals.org on 5 January 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics January 2021Volume 174, Issue 1Page: OC1 ePublished: 5 January 2021 Issue Published: January 2021 CopyrightCopyright © 2021 by American College of Physicians. All Rights Reserved.Loading ...