POLYMYALGIA RHEUMATICA

General:   Polymyalgia rheumatic (PMR) is the most common inflammatory condition  in older adults.  PMR causes pain in  muscles and joints in the hips, shoulders, and neck.  It affects older adults, and seems to have a predisposition towards people who are of Northern European descent.  PMR onset peaks at 70 to 80 years of age, and is rarely seen in people younger than 50 years old.  Women are affected more often than men.  PMR is known to coexist with another medical condition called giant cell arteritis that attacks certain blood vessels. 

Causes:   PMR is thought to be an autoimmune disease where the immune system malfunctions and attacks its own body, but its exact cause is unknown.  There may be a genetic component that is activated by environmental triggers.  Inflammation occurs that targets the shoulders and hips. 

Symptoms:  PMR causes dull, achy pain and stiffness in the shoulders in almost all cases.  The hips and neck can also be involved.  The symptoms will be in the same areas on both sides of the body.  Some patients will feel generally unwell, with fatigue, and low-grade fevers.  If there is coexistent giant cell arteritis, then there may also be jaw pain, vision disturbances, and scalp tenderness. 

Because PMR affects the shoulders and hips, people report having difficulties with many normal daily activities, such as getting up from a lying or sitting position.  There should not be any true weakness with PMR.

Dx:  There is no definitive test for PMR, so diagnosis is difficult.  PMR should be considered when patients have the typical symptoms like pain, stiffness, and loss of function in the shoulders and hips that lasts for 2 weeks or longer.  

Blood tests can be done to determine how much inflammation is generally present.  One test in particular, the Erythrocyte Sedimentation Rate (ESR), is particularly useful in PMR.  In almost all cases of PMR, the ESR is elevated above mm/hr 40 but less than 100, with an average level around 60.  Because PMR symptoms can be vague and can mimic many other conditions and syndromes extensive blood testing and imaging may be done.  Tis should include a complete rheumatologic panel of tests to rule out other autoimmune and inflammatory conditions such as rheumatoid arthritis.

Treatment:   Low dose daily corticosteroids are helpful in resolving PMR.   Daily oral tablets of prednisone, or monthly steroid injections can be used. Symptoms should improve rapidly or a month, nd then the corticosteroid dose can be reduced to maintain resolution without flare-ups. Treatment may have to continue for 1 to 2 years.  Because corticosteroids cause osteoporosis (“weak bones”), all patients receiving treatment should discuss how to maintain bone health with their physicians.   For mild symptoms, nonsteroidal anti-inflammatory medications (NSAIDs) may be used. 

Self-management:  Rest, in the form of activity modifications as well as sleep, should be helpful in managing PMR.  Healthy anti-inflammatory diet is always important.