Case Report
Pleural and Pericardial Effusion in a Patient With Polymyalgia Rheumatica: A Case Presentation
Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática
Elena Sánchez Ruiz-Granados
, Matilde del Castillo Madrigal, Manuel Jesús Romero Jiménez
Corresponding author
Departamento de Medicina Interna, Hospital Infanta Elena, Huelva, Spain
Read
9752
Timeswas read the article
2295
Total PDF
7457
Total HTML
Share statistics
array:24 [ "pii" => "S2173574313000555" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.10.006" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "528" "copyright" => "Elsevier España, S.L.. All rights reserved" "copyrightAnyo" => "2012" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2013;9:376-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3823 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 3262 "PDF" => 507 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X13000144" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2012.10.017" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "528" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2013;9:376-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6583 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 4810 "PDF" => 1618 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Caso clínico</span>" "titulo" => "Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "376" "paginaFinal" => "378" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Pleural and pericardial effusion in a patient with polymyalgia rheumatica: A case presentation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 900 "Tamanyo" => 87771 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Radiografía de tórax.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Elena Sánchez Ruiz-Granados, Matilde del Castillo Madrigal, Manuel Jesús Romero Jiménez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Elena" "apellidos" => "Sánchez Ruiz-Granados" ] 1 => array:2 [ "nombre" => "Matilde" "apellidos" => "del Castillo Madrigal" ] 2 => array:2 [ "nombre" => "Manuel Jesús" "apellidos" => "Romero Jiménez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574313000555" "doi" => "10.1016/j.reumae.2012.10.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000555?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13000144?idApp=UINPBA00004M" "url" => "/1699258X/0000000900000006/v3_201409200209/S1699258X13000144/v3_201409200209/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574313001081" "issn" => "21735743" "doi" => "10.1016/j.reumae.2013.01.018" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "536" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2013;9:379-80" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2859 "formatos" => array:3 [ "EPUB" => 52 "HTML" => 2300 "PDF" => 507 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Fever and Exanthema in a Young Patient: Drug Reaction With Eosinophilia and Systemic Symptoms due to Allopurinol" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "379" "paginaFinal" => "380" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fiebre y exantema en un paciente joven: reacción a medicamentos con eosinofilia y síntomas sistémicos al alopurinol al alopurinol" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 761 "Ancho" => 1000 "Tamanyo" => 124257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rash and edema on the extremities.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Francisco Gallo Puelles, Alejandro Muñoz Jiménez, M. Luisa Velloso Feijoó, Mario Leon Garcia, Sergio Rodriguez Montero, José Luis Marenco de la Fuente" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Francisco" "apellidos" => "Gallo Puelles" ] 1 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Muñoz Jiménez" ] 2 => array:2 [ "nombre" => "M. Luisa" "apellidos" => "Velloso Feijoó" ] 3 => array:2 [ "nombre" => "Mario" "apellidos" => "Leon Garcia" ] 4 => array:2 [ "nombre" => "Sergio" "apellidos" => "Rodriguez Montero" ] 5 => array:2 [ "nombre" => "José Luis" "apellidos" => "Marenco de la Fuente" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X13000260" "doi" => "10.1016/j.reuma.2013.01.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13000260?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313001081?idApp=UINPBA00004M" "url" => "/21735743/0000000900000006/v1_201311210124/S2173574313001081/v1_201311210124/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173574313000580" "issn" => "21735743" "doi" => "10.1016/j.reumae.2012.11.006" "estado" => "S300" "fechaPublicacion" => "2013-11-01" "aid" => "534" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2013;9:373-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4341 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 3627 "PDF" => 660 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Systemic Lupus Erythematosus and Thrombotic Thrombocytopenia Purpura: A Refractory Case Without Lupus Activity" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "373" "paginaFinal" => "375" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lupus eritematoso sistémico y púrpura trombótica trombocitopénica: un caso refractario sin actividad lúpica asociada" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1212 "Ancho" => 2211 "Tamanyo" => 173098 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Evolution of Laboratory Parameters and Therapeutic Options in the Current Case.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raimundo Garcia Boyero, Eva Mas Esteve, Maria Mas Esteve, M. Magdalena Millá Perseguer, Josefa Marco Buades, Juan Beltran Fabregat, Guillermo Cañigral Ferrando, Miguel Angel Belmonte Serrano" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Raimundo" "apellidos" => "Garcia Boyero" ] 1 => array:2 [ "nombre" => "Eva" "apellidos" => "Mas Esteve" ] 2 => array:2 [ "nombre" => "Maria" "apellidos" => "Mas Esteve" ] 3 => array:2 [ "nombre" => "M. Magdalena" "apellidos" => "Millá Perseguer" ] 4 => array:2 [ "nombre" => "Josefa" "apellidos" => "Marco Buades" ] 5 => array:2 [ "nombre" => "Juan" "apellidos" => "Beltran Fabregat" ] 6 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Cañigral Ferrando" ] 7 => array:2 [ "nombre" => "Miguel Angel" "apellidos" => "Belmonte Serrano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X13000247" "doi" => "10.1016/j.reuma.2012.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X13000247?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000580?idApp=UINPBA00004M" "url" => "/21735743/0000000900000006/v1_201311210124/S2173574313000580/v1_201311210124/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Pleural and Pericardial Effusion in a Patient With Polymyalgia Rheumatica: A Case Presentation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "376" "paginaFinal" => "378" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Elena Sánchez Ruiz-Granados, Matilde del Castillo Madrigal, Manuel Jesús Romero Jiménez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Elena" "apellidos" => "Sánchez Ruiz-Granados" "email" => array:1 [ 0 => "elenaschezrg@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Matilde" "apellidos" => "del Castillo Madrigal" ] 2 => array:2 [ "nombre" => "Manuel Jesús" "apellidos" => "Romero Jiménez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Medicina Interna, Hospital Infanta Elena, Huelva, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 900 "Tamanyo" => 87771 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polymyalgia reumatica (PMR) is an inflammatory disease of unknown cause characterized by pain and morning stiffness in the cervical region, shoulders and shoulder girdle.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its frequency is increased in patients over 50 years and is two times more common in women. The annual incidence in Europe and in the United States varies between 1.3 and 11.3 per 10<span class="elsevierStyleHsp" style=""></span>000 individuals over the age of 50 years.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The association of pericardial effusion (PE) and PMR has rarely been reported. So far, three cases of PMR<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> associated to PE have been documented and only one with pericardial and pleural effusion. 2 cases of associated cardiac tamponade with PMR have also been recorded.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case Presentation</span><p id="par0020" class="elsevierStylePara elsevierViewall">Here we present the case of an 80-year-old man with a history of hypertension, type 2 diabetes mellitus and chronic atrial fibrillation without anticoagulant and with a history of gastrointestinal bleeding, who was admitted for asthenia, anorexia and weight loss of 3 months duration. Coinciding with this, he had polyarticular pain and morning stiffness, especially in the shoulders and hips, preventing him from walking in the last 3 months. He had no headache.</p><p id="par0025" class="elsevierStylePara elsevierViewall">He was under treatment with omeprazole, domperidone, amlodipine, digoxin, furosemide, metformin and ramipril.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Physical examination showed mild mucocutaneous pallor and decreased breath sounds of the left thorax; the remainder of the examination was normal.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The initial laboratory results highlighted a normocytic, normochromic anemia, Hb 10.2<span class="elsevierStyleHsp" style=""></span>g/dl, normal leukocytes and platelets. The erythrocyte sedimentation rate (ESR) was 105<span class="elsevierStyleHsp" style=""></span>mm/h, CRP 13<span class="elsevierStyleHsp" style=""></span>mg/dl and proteins 6.3<span class="elsevierStyleHsp" style=""></span>mg/dl. Renal function tests were performed and anemia was studied measuring ferritin, vitamin B<span class="elsevierStyleInf">12</span> and folic acid, all of them being normal. Proteingram showed increased alpha 2 and normal tumor markers (CA 19-9, CEA, AFP, chorionic gonadotropin), all negative, TSH normal, Mantoux negative. ANA and ANCA negative, complement (C3 and C4) normal.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The chest X-ray showed cardiomegaly on admission, with no other findings. A few days later the patient presented an associated bilateral pleural effusion, predominantly on the left side (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A CT of the chest and abdomen reported a pericardial and pleural effusion, moderate in amount and of free morphology, causing a passive collapse of the basal segments of both lower lobes with the rest showing no abnormalities.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">A thoracentesis allowed us to examine the pleural fluid with the following results: LDH 104<span class="elsevierStyleHsp" style=""></span>U/l, protein 3.1<span class="elsevierStyleHsp" style=""></span>g/dl, glucose 116<span class="elsevierStyleHsp" style=""></span>mg/dl, pH 7.52 and normal ADA (transudate characteristics, but in the threshold between exudate and transudate). Fluid cytology: serosanguineous, absence of neoplastic cells.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Subsequently, echocardiography showed: left ventricular hypertrophy, with conserved size and systolic function, mild mitral and aortic insufficiency, with the rest of the valves normal, slight pulmonary hypertension and moderate anterior pericardial effusion and moderate to severe posteriorly with fibrin without collapse during dyastole of the right chambers (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Since the patient had criteria compatible with PMR (age >50 years, pain on the proximal muscles, shoulders and hip, ESR >40<span class="elsevierStyleHsp" style=""></span>mm/h and we excluded other diagnoses), we confirmed the diagnosis and the patient was treated with prednisone at a dose of 15<span class="elsevierStyleHsp" style=""></span>mg daily.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Clinical improvement was evident in the first 48<span class="elsevierStyleHsp" style=""></span>h, with increased mobility and a clear decrease in rigidity, especially at the level of the shoulder girdle, with the patient being able to walk. Likewise there were decreased inflammatory markers and the X-rays showed a marked decrease of the pleural effusion. The echocardiography performed after one month showed that the pericardial effusion had completely disappeared with only a slight right pleural effusion.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">PMR patients present bilateral discomfort involving the proximal parts of the limbs and joints in relation to synovitis of proximal joints.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The combination of persistent pain for at least a month, with pain and morning stiffness in the neck region, the shoulder girdle and the pelvic girdle, lasting at least 30<span class="elsevierStyleHsp" style=""></span>min, associated with an increase in ESR of at least 40<span class="elsevierStyleHsp" style=""></span>mm per hour, is highly indicative of polymyalgia reumatica.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Musculoskeletal pain worsens with movement of the affected areas and typically interferes with activities of daily living.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Shoulder pain is present finding in most of patients (70%–95%), however the hips and neck are less frequently affected (50%–70%). In the shoulders and pelvic girdle pain usually radiates distally into the elbows and knees. The discomfort may start on one side but quickly becomes bilateral.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Systemic symptoms are common, being present in one third of patients, and include fever, fatigue, anorexia and weight loss.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> In our case, the reason for admission was mainly fatigue and weight loss, but after asking specific questions the patient informed us of proximal muscle pain.</p><p id="par0085" class="elsevierStylePara elsevierViewall">On examination, there is limitation of active movements and, often, also passive movements are limited due to pain.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Generally, the diagnosis is made after 2 or 3 months since the onset of symptoms.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Analytically, most patients have mild anemia of chronic disorders, as in our case, and one third of patients have altered liver function tests.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Rheumatoid factor and ANA are usually negative.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Corticosteroids are used to treat patients at a dose of 10–20<span class="elsevierStyleHsp" style=""></span>mg. The response to corticosteroids is rapid, with resolution of symptoms within days it after the start of therapy. A lack of improvement should lead us to question the diagnosis. The initial dose is usually maintained for 2–4 weeks, and subsequently it can be gradually reduced every week or every two weeks at a maximum rate of 10% every two weeks from the total daily dose. If the steroid dose is reduced or withdrawn too quickly, symptoms may recur. However, approximately 30%–50% of patients have spontaneous exacerbations, and a course of treatment for one or two years is often required. Some patients have a relapsing course and may require low-dose corticosteroids for several years.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Given the clinical presentation of anorexia and weight loss associated with pleural and pericardial effusion, different diagnoses such as tumors, tuberculosis and autoimmune diseases might be suspected, all of which are reasonably discarded when the CT is normal, and Mantoux ADA are negative and, for the case of autoimmune diseases, ANA and ANCA and complement, were negative and clinical presentation was not consistent with these diseases. The diagnosis of rheumatoid arthritis was also considered, which seemed unlikely due to the clinical presentation; in rheumatoid arthritis peripheral joints are more commonly affected, and is characterized by a negative rheumatoid factor. The acute edematous polysynovitis of the elderly (RS3P3), is also a diagnosis that should be considered when joint pain occurs in older people and is characterized, as is PMR, by an excellent prognosis with low doses of corticosteroids; this was excluded since the patient had no synovitis of the distal joints and showed no edema of the back of the hands.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In our patient, clinical improvement was evident within days of initiation of low-dose corticosteroids. One month after treatment, the pericardial effusion completely disappeared and pleural effusion improved considerably.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The presentation of joint pain and stiffness of long duration, accompanying systemic symptoms (anorexia and weight loss), laboratory data (increased ESR and CRP) and a fast response to steroids confirmed the diagnosis of PMR.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical Responsibilities</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of People and Animals</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors state that no experiments were performed on humans or animals.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data Confidentiality</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors state that no patient data appears in this article.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to Privacy and Informed Consent</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors state that no patient data appears in this article.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of Interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres293716" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec277702" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres293715" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec277703" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case Presentation" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Protection of People and Animals" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Data Confidentiality" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Right to Privacy and Informed Consent" ] ] ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-10-14" "fechaAceptado" => "2012-10-23" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec277702" "palabras" => array:3 [ 0 => "Polymyalgia rheumatica" 1 => "Pericardial effusion" 2 => "Pleural effusion" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec277703" "palabras" => array:3 [ 0 => "Polimialgia reumática" 1 => "Derrame pericárdico" 2 => "Derrame pleural" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. It affects individuals over 50 years of age and it is usually associated with a raised erythrocyte sedimentation rate. Classically, treatment with low-dose corticosteroids results in a dramatic improvement in both symptoms and laboratory findings.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We report the case of an 80-year-old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Polymyalgia rheumatica is a common disease but it is rarely associated to pleuropericardial effusion. It should be considered in the differential diagnostic in patients presenting with pericardial effusion over 50 years of age due to the good response to treatment.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La polimialgia reumática es una enfermedad inflamatoria reumática que se caracteriza por dolor y rigidez bilateral que afecta principalmente a la musculatura proximal. Aparece sobre todo en personas por encima de los 50 años y se asocia a una velocidad de sedimentación globular elevada en la analítica. La enfermedad generalmente responde muy bien a dosis bajas de corticoides.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A continuación, presentamos el caso de un varón de 80años que presentó un cuadro compatible con polimialgia reumática asociado a derrame pleuropericárdico que respondió rápidamente a corticoides, con rápida mejoría en la sintomatología y en los hallazgos de laboratorio.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La polimialgia reumática es una enfermedad que se presenta con relativa frecuencia pero que raramente se asocia a derrame pleuropericárdico. Es importante tenerla en cuenta en el diagnóstico diferencial del derrame pericárdico en personas mayores de 50años por su buena respuesta a tratamiento.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez Ruiz-Granados E, et al. Presentación de un caso de derrame pleurocárdico en un paciente diagnosticado de polimialgia reumática. Reumatol Clin. 2013;9:376–378.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 893 "Ancho" => 900 "Tamanyo" => 87771 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chest X-ray.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 636 "Ancho" => 900 "Tamanyo" => 90937 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">CT of the chest and abdomen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and giant cell arteritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Salvarani" 1 => "F. Cantini" 2 => "L. Boiardi" 3 => "G.G. Hunder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra011913" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2002" "volumen" => "347" "paginaInicial" => "261" "paginaFinal" => "277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12140303" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica – diagnosis and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O. Van Hecke" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Aust Fam Physician" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "303" "paginaFinal" => "306" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21597550" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673608607254" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica: a 10-year epidemiologic and clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Chuang" 1 => "G. Hunder" 2 => "D. Ilstrup" 3 => "L.T. Kurland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1982" "volumen" => "97" "paginaInicial" => "672" "paginaFinal" => "680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6982645" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Bohan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1984" "volumen" => "101" "paginaInicial" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6732086" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. Cobo" 1 => "Z. Zubera Salibarria" 2 => "J. Munoz Sanchez" 3 => "J.M. Santamaria Jauregui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Intern Med" "fecha" => "1991" "volumen" => "8" "paginaInicial" => "362" "paginaFinal" => "363" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica as an unusual cause of pleural and pericardial effusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.B. Malone" 1 => "G.M. McCarthy" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Clin Rheumatol" "fecha" => "2005" "volumen" => "11" "paginaInicial" => "59" "paginaFinal" => "60" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16357699" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and pericardial tamponade" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Brucato" 1 => "G. Brambilia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2002" "volumen" => "61" "paginaInicial" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11830449" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pericardial tamponade in a patient with polymyalgia rheumatica" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Calvo" 1 => "E. Becerra" 2 => "F.J. López-Longo" 3 => "F.J. Cabrera" 4 => "L. Carreño" 5 => "A. Paravisini" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp Rheumatol" "fecha" => "2009" "volumen" => "1" "numero" => "Suppl. 52" "paginaInicial" => "S83" "paginaFinal" => "S85" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Salvarani" 1 => "P. Macchioni" 2 => "L. Boiardi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(97)05001-0" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "1997" "volumen" => "350" "paginaInicial" => "43" "paginaFinal" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9217726" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Salvarani" 1 => "P.L. Macchioni" 2 => "P.L. Tartoni" 3 => "F. Rossi" 4 => "R. Baricchi" 5 => "C. Castri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Italy Clin Exp Rheumatol" "fecha" => "1987" "volumen" => "5" "paginaInicial" => "205" "paginaFinal" => "215" "itemHostRev" => array:3 [ "pii" => "S0190962210021596" "estado" => "S300" "issn" => "01909622" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000900000006/v1_201311210124/S2173574313000555/v1_201311210124/en/main.assets" "Apartado" => array:4 [ "identificador" => "17376" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000900000006/v1_201311210124/S2173574313000555/v1_201311210124/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574313000555?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 14 | 28 |
| 2024 October | 85 | 33 | 118 |
| 2024 September | 94 | 24 | 118 |
| 2024 August | 100 | 36 | 136 |
| 2024 July | 112 | 37 | 149 |
| 2024 June | 119 | 44 | 163 |
| 2024 May | 89 | 29 | 118 |
| 2024 April | 119 | 24 | 143 |
| 2024 March | 76 | 28 | 104 |
| 2024 February | 100 | 33 | 133 |
| 2024 January | 101 | 26 | 127 |
| 2023 December | 67 | 27 | 94 |
| 2023 November | 74 | 30 | 104 |
| 2023 October | 70 | 36 | 106 |
| 2023 September | 100 | 38 | 138 |
| 2023 August | 69 | 15 | 84 |
| 2023 July | 73 | 29 | 102 |
| 2023 June | 74 | 28 | 102 |
| 2023 May | 70 | 29 | 99 |
| 2023 April | 52 | 15 | 67 |
| 2023 March | 85 | 27 | 112 |
| 2023 February | 78 | 30 | 108 |
| 2023 January | 69 | 21 | 90 |
| 2022 December | 66 | 33 | 99 |
| 2022 November | 59 | 30 | 89 |
| 2022 October | 82 | 32 | 114 |
| 2022 September | 60 | 79 | 139 |
| 2022 August | 54 | 45 | 99 |
| 2022 July | 69 | 54 | 123 |
| 2022 June | 51 | 43 | 94 |
| 2022 May | 84 | 36 | 120 |
| 2022 April | 97 | 35 | 132 |
| 2022 March | 101 | 39 | 140 |
| 2022 February | 145 | 49 | 194 |
| 2022 January | 87 | 52 | 139 |
| 2021 December | 38 | 34 | 72 |
| 2021 November | 72 | 45 | 117 |
| 2021 October | 75 | 53 | 128 |
| 2021 September | 75 | 36 | 111 |
| 2021 August | 54 | 37 | 91 |
| 2021 July | 35 | 41 | 76 |
| 2021 June | 53 | 29 | 82 |
| 2021 May | 49 | 39 | 88 |
| 2021 April | 184 | 71 | 255 |
| 2021 March | 75 | 25 | 100 |
| 2021 February | 66 | 31 | 97 |
| 2021 January | 50 | 27 | 77 |
| 2020 December | 55 | 19 | 74 |
| 2020 November | 110 | 17 | 127 |
| 2020 October | 145 | 13 | 158 |
| 2020 September | 30 | 26 | 56 |
| 2020 August | 28 | 8 | 36 |
| 2020 July | 30 | 17 | 47 |
| 2020 June | 42 | 14 | 56 |
| 2020 May | 43 | 14 | 57 |
| 2020 April | 29 | 8 | 37 |
| 2020 March | 11 | 4 | 15 |
| 2020 February | 1 | 0 | 1 |
| 2019 April | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 August | 0 | 1 | 1 |
| 2018 May | 3 | 3 | 6 |
| 2018 April | 52 | 7 | 59 |
| 2018 March | 72 | 6 | 78 |
| 2018 February | 46 | 6 | 52 |
| 2018 January | 43 | 3 | 46 |
| 2017 December | 39 | 7 | 46 |
| 2017 November | 47 | 6 | 53 |
| 2017 October | 42 | 2 | 44 |
| 2017 September | 66 | 16 | 82 |
| 2017 August | 79 | 12 | 91 |
| 2017 July | 65 | 10 | 75 |
| 2017 June | 90 | 12 | 102 |
| 2017 May | 104 | 12 | 116 |
| 2017 April | 74 | 7 | 81 |
| 2017 March | 95 | 13 | 108 |
| 2017 February | 48 | 11 | 59 |
| 2017 January | 49 | 12 | 61 |
| 2016 December | 103 | 18 | 121 |
| 2016 November | 68 | 11 | 79 |
| 2016 October | 93 | 14 | 107 |
| 2016 September | 117 | 11 | 128 |
| 2016 August | 98 | 14 | 112 |
| 2016 July | 51 | 9 | 60 |
| 2016 June | 1 | 0 | 1 |
| 2016 May | 1 | 0 | 1 |
| 2016 April | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 1 | 0 | 1 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 3 | 0 | 3 |
| 2015 July | 41 | 6 | 47 |
| 2015 June | 66 | 9 | 75 |
| 2015 May | 103 | 21 | 124 |
| 2015 April | 105 | 16 | 121 |
| 2015 March | 88 | 9 | 97 |
| 2015 February | 91 | 8 | 99 |
| 2015 January | 76 | 7 | 83 |
| 2014 December | 92 | 15 | 107 |
| 2014 November | 79 | 10 | 89 |
| 2014 October | 79 | 16 | 95 |
| 2014 September | 72 | 9 | 81 |
| 2014 August | 86 | 15 | 101 |
| 2014 July | 85 | 13 | 98 |
| 2014 June | 101 | 14 | 115 |
| 2014 May | 98 | 16 | 114 |
| 2014 April | 92 | 11 | 103 |
| 2014 March | 82 | 17 | 99 |
| 2014 February | 90 | 23 | 113 |
| 2014 January | 75 | 23 | 98 |
| 2013 December | 82 | 19 | 101 |
| 2013 November | 21 | 7 | 28 |
Show all
