[Polymyalgia rheumatica: new developments and challenges]. / Polymyalgia rheumatica.

- Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder in which inflammation markers, both erythrocyte sedimentation rate (ESR) and CRP values, are often elevated. However, a non-abnormal ESR or CRP value does not preclude the diagnosis.- PMR is an arbitrary diagnosis and presents both diagnostic and therapeutic challenges.- Imaging diagnostics, such as echography, MRI or FDG-PET/CT, may potentially be applied more frequently as a second-line investigation when there is doubt concerning the diagnosis. Currently these additional imaging techniques are not applied in first line diagnostics.- Glucocorticoids remain the cornerstone treatment for polymyalgia rheumatica. Often patients react swiftly to this, but in 29-45% of cases an effect is only observed 3-4 weeks later. The treatment course typically lasts 1-3 years.- More research has been conducted into potential glucocorticoid-sparing treatments. Most of the scientific evidence concerns the effectiveness of methotrexate; there is some evidence regarding the effectiveness of azathioprine and leflunomide. Tocilizumab, an IL-6 receptor inhibitor, has shown promise as a treatment, but further evidence is required.

Prediction of extreme floods in the eastern Central Andes based on a complex networks approach.

Changing climatic conditions have led to a significant increase in the magnitude and frequency of extreme rainfall events in the Central Andes of South America. These events are spatially extensive and often result in substantial natural hazards for population, economy and ecology. Here we develop a general framework to predict extreme events by introducing the concept of network divergence on directed networks derived from a non-linear synchronization measure. We apply our method to real-time satellite-derived rainfall data and predict more than 60% (90% during El Niño conditions) of rainfall events above the 99th percentile in the Central Andes. In addition to the societal benefits of predicting natural hazards, our study reveals a linkage between polar and tropical regimes as the responsible mechanism: the interplay of northward migrating frontal systems and a low-level wind channel from the western Amazon to the subtropics.