%PDF-1.4
%
49 0 obj
<>
endobj
46 0 obj
<>
endobj
100 0 obj
<>stream
Acrobat Distiller 4.05 for Macintosh
2005-05-11T10:11:11Z
2024-03-29T08:43:59-07:00
QuarkXPressª: AdobePS 8.8.0 (301)
2024-03-29T08:43:59-07:00
application/pdf
Heather
2004-496.june
uuid:53b8251e-1dd2-11b2-0a00-6009275d6100
uuid:53b82520-1dd2-11b2-0a00-aa0000000000
endstream
endobj
35 0 obj
<>
endobj
36 0 obj
<>
endobj
50 0 obj
<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Thumb 23 0 R/Type/Page>>
endobj
1 0 obj
<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Thumb 25 0 R/Type/Page>>
endobj
4 0 obj
<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/Thumb 27 0 R/Type/Page>>
endobj
15 0 obj
<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 0/Thumb 29 0 R/Type/Page>>
endobj
114 0 obj
[118 0 R]
endobj
115 0 obj
<>stream
1 g
/GS0 gs
0 792 m
0 792 l
f
q
13.5 787.5 585 -783 re
W n
q
0 792.03 612 -792 re
W n
BT
0 0 0 1 k
/GS1 gs
/T1_0 1 Tf
-0.00011 Tc 10 0 0 10 54 734.8264 Tm
(DISCUSSION )Tj
/T1_1 1 Tf
0.03439 Tw 0 -1.2 TD
(No single clinical or laboratory feature was on its own able)Tj
0.1545 Tw T*
[(to dif)17.7 (ferentiate between LORA)-349.7 (with PMS and PMR. )17.7 (The)]TJ
0.2507 Tw T*
[(diagnosis of LORA)-445.9 (was delayed from between 1 to 30)]TJ
0.0307 Tw T*
[(months in 6% of cases. )54.8 (A)-225.8 (delay in diagnosing RA)-225.9 (occurs in)]TJ
0.0154 Tw T*
[(3\3201)36.8 (1% of individuals)]TJ
0 Tc 0 Tw 7.5 0 0 7.5 140.0362 678.1265 Tm
(4,8)Tj
-0.00011 Tc 0.0155 Tw 10 0 0 10 149.4112 674.8264 Tm
[(. In our study)64.8 (, RF positivity was not)]TJ
0.04401 Tw -9.5411 -1.2 Td
(an exclusion factor in considering the diagnosis of PMR. It)Tj
0.28529 Tw T*
(is reported that in the general population RF positivity)Tj
-0.0294 Tw T*
(increases with age, so that 12% of \322healthy\323 people over age)Tj
-0.033 Tw T*
(60 will be RF positive)Tj
0 Tc 0 Tw 7.5 0 0 7.5 141.565 630.1265 Tm
(9)Tj
-0.00011 Tc -0.033 Tw 10 0 0 10 145.315 626.8264 Tm
[(. However)39.7 (, our results do suggest that)]TJ
-0.0106 Tw -9.1315 -1.2 Td
[(RF positivity is a strong indicator of LORA)-184.6 (in someone pre-)]TJ
0.02499 Tw T*
(senting with PMS.)Tj
0.1192 Tw 1.2 -1.2 Td
[(Clinically)64.8 (, the arthritis of LORA)-314.5 (and that presenting in)]TJ
0.02679 Tw -1.2 -1.2 Td
[(PMR can be similar)54.8 (. However)39.7 (, detailed imaging of some of)]TJ
0.0497 Tw T*
(our cases with magnetic resonance imaging has shown sig-)Tj
0.0313 Tw T*
[(nificant dif)17.7 (ferences in the arthropathy of PMR compared to)]TJ
0 Tw T*
(RA)Tj
0 Tc 7.5 0 0 7.5 67.8892 546.1265 Tm
[(10,1)49.2 (1)]TJ
10 0 0 10 84.3955 542.8264 Tm
(.)Tj
-0.00011 Tc 0.0883 Tw -1.8396 -1.2 Td
[(PMS symptoms were common in our )17.7 (T)79.9 (A)-283.4 (cohort. Sixty-)]TJ
0.1256 Tw -1.2 -1.2 Td
[(nine percent of patients with )17.8 (T)79.9 (A)-320.7 (had PMS symptoms that)]TJ
0.0631 Tw T*
[(started before onset of classical )17.7 (T)79.9 (A)-258.2 (symptoms. )17.7 (The time to)]TJ
0.1144 Tw T*
[(onset of )17.7 (T)79.9 (A)-309.5 (symptoms varied considerably \(up to 1)36.7 (1 yrs\).)]TJ
0.0188 Tw T*
[(HLA-DRB1*04 was more common in those developing )17.8 (T)79.9 (A)]TJ
0.0992 Tw T*
(who had PMS than those with PMR alone. Similar results)Tj
0.0667 Tw T*
[(for PMR-T)79.7 (A)-261.8 (or indeed )17.7 (T)79.9 (A)-261.9 (without PMR have been report-)]TJ
-0.0002 Tc 0 Tw T*
(ed)Tj
-0.00011 Tc 7.5 0 0 7.5 63.4385 450.1265 Tm
(12-14)Tj
0.07201 Tw 10 0 0 10 80.9342 446.8264 Tm
(. In other parts of Europe no association with HLA-)Tj
0 Tc 0.2056 Tw -2.6934 -1.2 Td
(DRB1*04 has been found)Tj
0 Tw 7.5 0 0 7.5 163.7604 438.1265 Tm
(15)Tj
-0.00011 Tc 0.2056 Tw 10 0 0 10 171.2604 434.8264 Tm
[(. )17.7 (The HLA-DRB1 typing for)]TJ
0.19749 Tw -11.726 -1.2 Td
[(patients with PMR was not dif)17.7 (ferent from those patients)]TJ
0.02499 Tw T*
[(with RA)-220.2 (presenting with PMS.)]TJ
0.0647 Tw 1.2 -1.2 Td
[(W)79.9 (e felt that those cases finally diagnosed as LORA)-259.9 (had)]TJ
-0.03 Tw -1.2 -1.2 Td
[(subclinical RA)-165.2 (at presentation, rather than the disease evolv-)]TJ
0.02769 Tw T*
[(ing into RA. )17.7 (The presence of high titer RF at first presenta-)]TJ
0.0174 Tw T*
[(tion may be an indicator of underlying RA)-212.5 (in those present-)]TJ
0.0692 Tw T*
[(ing with PMS, even in the absence of typical arthritis. )17.7 (The)]TJ
0.0049 Tw T*
[(RF-negative RA)-200.1 (patients had persistent joint disease despite)]TJ
0.02499 Tw T*
(steroids, and all became erosive over time.)Tj
0.01759 Tw 1.2 -1.2 Td
(In this group of conditions with overlapping clinical fea-)Tj
0.20621 Tw -1.2 -1.2 Td
(tures and where diagnostic features may be delayed, the)Tj
0.17979 Tw T*
(change of the initial diagnosis should be flexible, with a)Tj
0.15581 Tw T*
(final diagnosis dependent on the evolving clinical picture)Tj
-0.02361 Tw T*
(and response to treatment. HLA-DRB1 typing and RF status)Tj
0.0619 Tw T*
(may in some patients help to clarify the diagnosis and pre-)Tj
0.02499 Tw T*
[(dict future )17.7 (T)79.9 (A)-220.1 (in those with PMS.)]TJ
/T1_0 1 Tf
0 Tw 26.4 49.2 Td
(REFERENCES)Tj
/T1_1 1 Tf
0.02499 Tw 8 0 0 8 325 724.8264 Tm
[(1.)-875.1 (Caporali R, Montecucco C, Epis O, Bobbio-Pallavicini F)79.7 (, Maio )17.7 (T)74 (,)]TJ
1.675 -1.25 Td
(Cimmino MA. Presenting features of polymyalgia rheumatica)Tj
0 -1.25 TD
(\(PMR\) and rheumatoid arthritis with PMR-like onset: a prospective)Tj
0 Tc T*
[(study)65 (. )54.9 (Ann Rheum Dis 2001;60:1021-4.)]TJ
-0.00011 Tc -1.675 -1.25 Td
[(2.)-875.1 (Pease CT)73.9 (, Bhakta BB, Devlin J, Emery P)110.7 (. Does the age of onset of)]TJ
1.675 -1.25 Td
(rheumatoid arthritis influence phenotype?: a prospective study of)Tj
T*
(outcome and prognostic factors. Rheumatology Oxford)Tj
0 Tc 0 Tw T*
(1999;38:228-34.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(3.)-875.1 (Haugeber)17.7 (g G, Paulsen PQ, Bie RB. )17.7 (T)69.9 (emporal arteritis in )17.7 (V)110.8 (est )54.8 (Agder)]TJ
1.675 -1.25 Td
(County in southern Norway: incidence and clinical findings.)Tj
T*
(J Rheumatol 2000;27:2624-7.)Tj
-1.675 -1.25 Td
[(4.)-875.1 (Gran JT)73.9 (, Myklebust G. )17.7 (The incidence and clinical characteristics of)]TJ
1.675 -1.25 Td
(peripheral arthritis in polymyalgia rheumatica and temporal )Tj
T*
(arteritis: a prospective study of 231 cases. Rheumatology Oxford)Tj
0 Tc 0 Tw T*
(2000;39:283-7.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(5.)-875.1 (Arnett FC, Edworthy SM, Bloch DA, et al. )17.7 (The )54.8 (American)]TJ
1.675 -1.25 Td
[(Rheumatism )54.8 (Association 1987 revised criteria for the classification)]TJ
T*
[(of rheumatoid arthritis. )54.8 (Arthritis Rheum 1988;31:315-24.)]TJ
-1.675 -1.25 Td
[(6.)-875.1 (Bird HA, Esselinckx )17.7 (W)91.8 (,)-0.1 ( Dixon )54.8 (AS, Mowat )54.8 (AG, )17.7 (W)79.9 (ood PH. )54.8 (An )]TJ
1.675 -1.25 Td
[(evaluation of criteria for polymyalgia rheumatica. )54.8 (Ann Rheum Dis)]TJ
0 Tc 0 Tw T*
(1979;38:434-9.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(7.)-875.1 (Hunder GG, Bloch DA, Michel BA, et al. )17.7 (The )54.8 (American College of)]TJ
1.675 -1.25 Td
(Rheumatology 1990 criteria for the classification of giant cell)Tj
T*
[(arteritis. )54.8 (Arthritis Rheum 1990;33:1)36.8 (122-8.)]TJ
-1.675 -1.25 Td
[(8.)-875.1 (Gonzalez-Gay MA, Garcia-Porrua C, )17.7 (V)110.8 (azquez-Caruncho M,)]TJ
1.675 -1.25 Td
[(Dababneh )54.8 (A, Hajeer )54.8 (A, Ollier )17.7 (WE. )17.7 (The spectrum of polymyalgia)]TJ
T*
(rheumatica in northwestern Spain: incidence and analysis of )Tj
T*
[(variables associated with relapse in a 10 year study)64.8 (. J Rheumatol)]TJ
0 Tc 0 Tw T*
(1999;26:1326-32.)Tj
-0.00011 Tc 0.02499 Tw -1.675 -1.25 Td
[(9.)-875.1 (van Schaardenbur)17.7 (g D, Lagaay )54.8 (AM, Otten HG, Breedveld FC. )17.7 (The)]TJ
1.675 -1.25 Td
(relation between class-specific serum rheumatoid factors and age in)Tj
T*
(the general population. Br J Rheumatol 1993;32:546-9. )Tj
-2.175 -1.25 Td
[(10.)-875.1 (McGonagle D, Pease C, Marzo-Ortega H, O\325Connor P)110.7 (, Emery P)110.7 (.)]TJ
2.175 -1.25 Td
(The case for classification of polymyalgia rheumatica and remitting)Tj
T*
(seronegative symmetrical synovitis with pitting edema as primarily)Tj
T*
(capsular/entheseal based pathologies. J Rheumatol 2000;27:837-40.)Tj
-2.1381 -1.25 Td
[(1)36.8 (1)-0.1 (.)-875.1 (McGonagle D, Pease C, Marzo-Ortega H, O\325Connor P)110.7 (,)-0.1 ( Gibbon )17.7 (W)91.8 (,)]TJ
2.1381 -1.25 Td
[(Emery P)110.7 (. Comparison of extracapsular changes by magnetic )]TJ
T*
(resonance imaging in patients with rheumatoid arthritis and)Tj
T*
(polymyalgia rheumatica. J Rheumatol 2001;28:1837-41.)Tj
-2.175 -1.25 Td
[(12.)-875.1 (Richardson JE, Gladman DD, Fam )54.8 (A, Keystone EC. HLA-DR4 in)]TJ
2.175 -1.25 Td
(giant cell arteritis: association with polymyalgia rheumatic)Tj
T*
[(a syndrome. )54.8 (Arthritis Rheum 1987;30:1293-7.)]TJ
-2.175 -1.25 Td
[(13.)-875.1 (Cid MC, Ercilla G, )17.7 (V)59.8 (ilaseca J, et al. Polymyalgia rheumatica: a)]TJ
2.175 -1.25 Td
[(syndrome associated with HLA-DR4 antigen. )54.8 (Arthritis Rheum)]TJ
0 Tc 0 Tw T*
(1988;31:678-82.)Tj
-0.00011 Tc 0.02499 Tw -2.175 -1.25 Td
[(14.)-875.1 (W)79.9 (eyand CM, Hunder NN, Hicok KC, Hunder GG, Goronzy JJ.)]TJ
2.175 -1.25 Td
(HLA-DRB1 alleles in polymyalgia rheumatica, giant cell arteritis,)Tj
T*
[(and rheumatoid arthritis. )54.8 (Arthritis Rheum 1994;37:514-20.)]TJ
-2.175 -1.25 Td
[(15.)-875.1 (Salvarani C, Boiardi L, Mantovani )17.7 (V)128.9 (, et al. HLA-DRB1 alleles)]TJ
2.175 -1.25 Td
(associated with polymyalgia rheumatica in northern Italy: )Tj
T*
[(correlation with disease severity)64.8 (. )54.8 (Ann Rheum Dis 1999;58:303-8.)]TJ
ET
0 0 0 1 K
53.964 76.5 m
558.972 76.5 l
S
0 0 0 0 k
52.822 69.665 64.178 -15.665 re
f*
BT
0 0 0 1 k
/T1_2 1 Tf
0 Tc 0 Tw 8 0 0 8 53.8216 56.7343 Tm
(1046)Tj
ET
0 0 0 0 k
356 69.665 203 -15.665 re
f*
BT
0 0 0 1 k
/T1_2 1 Tf
-0.00011 Tc 0.02499 Tw 8 0 0 8 424.3613 56.7343 Tm
(The Journal of Rheumatology 2005; 32:6)Tj
ET
0 0 0 0 k
/GS0 gs
104.631 81.583 407.5 -10.833 re
f*
0.5 w
/GS1 gs
104.631 81.583 407.5 -10.833 re
S
Q
Q
q
0 0 612 792 re
W n
BT
0 g
/GS2 gs
/T1_3 8 Tf
108.828 74 Td
(Personal non-commercial use only. The Journal of Rheumatology Copyright\
\251 2005. All rights reserved.)Tj
ET
Q
BT
0 g
/GS2 gs
/T1_4 1 Tf
10 0 0 10 540 17 Tm
( )Tj
0 0.48627 0.77255 rg
/GS2 gs
-7.22298 0 Td
(www.jrheum.org)Tj
0 g
/GS2 gs
-16.72996 0 Td
(Downloaded on March 29, 2024 from )Tj
ET
endstream
endobj
29 0 obj
<>stream
8;Z\6Mf-HU%-.A;0Y]F";*0=5#[))o:1Vf(G/uYg;rlRI=fJhl0KHC\gD`sqIpP?)
Y+N@BIG;GX%!5oX&sX6Rl
o<0U2QsP/1LL=-MHVYd6[9)*+o&2ZKIeA#$mt%,,Hjpb`U3G)#To4XGE:J\%P&C/3
15o'3pb'OZG"CM?jo-]G[9$2+_(p]o?e(Y::sYcou,TR?q<45X&j$5/fW/A](nI
/@UkPh/)g=iMKe;C`*i)g2HB+TBJ;Hl#>
endstream
endobj
33 0 obj
[/Indexed/DeviceRGB 255 32 0 R]
endobj
32 0 obj
<>stream
J,g]g+e/h_!_gCtO=0f)$P%cIi8Zdfc5&3j_8$7g.@L`YKUJNGBP\poR=_;Dl'P(T
(7Boo^^S:71(MN]ZQX/+Cbu.lK"p74pe1T%s.DY%&\1TdJhr54.M9au6>79n6`Q:4
PbLSZTLEE(8E@'*1mg_*eTnN*;*'V3+gm-EEetX%;Bo$ur2ss*N`.-!.kG_q6GDD'
dKoL!8Ka#EV,@V!\j8ZFbp6EE<9cn=N6j0nf;(&;QU6bUD')c@\
9-d\DA=cZ0Q>gIM$$;cd2O@&a;X,Nn_aP(]I1aRc(K1^ue>
gF/(+GaKo$qneLWDrQ#;5\S(\$q'4Q,85`-8;S(=Z"WSBOV*FM)4,?B],R
endstream
endobj
74 0 obj
<>
endobj
54 0 obj
<>
endobj
56 0 obj
<>
endobj
91 0 obj
<>
endobj
105 0 obj
<>
endobj
55 0 obj
<>
endobj
81 0 obj
<>stream
H|SkPWfpinjvPT,MEU(0 3 (yf0*Ek+F