Polymyalgia Rheumatica

What Is Polymyalgia Rheumatica?

Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes widespread muscle pain and stiffness, particularly in the shoulders, neck, upper arms, hips, and thighs. It almost exclusively affects people over 50 and is more common in women. The condition typically responds dramatically to corticosteroid treatment.¹

Symptoms²

• Pain and stiffness in shoulders and hips
• Symptoms worse in morning
• Stiffness lasting more than 45 minutes
• Difficulty raising arms overhead
• Trouble getting out of chair
• Fatigue and malaise
• Loss of appetite
• Unintentional weight loss
• Low-grade fever

Key Characteristics

• Age over 50 (usually over 70)
• Symptoms develop rapidly (over days to weeks)
• Both sides of body affected
• Dramatic response to prednisone
• Associated with elevated inflammation markers

Diagnosis³

• No single definitive test
• Elevated ESR and CRP
• Clinical presentation
• Response to steroids helps confirm
• Rule out other conditions
• Ultrasound may show bursitis

Giant Cell Arteritis Link

• PMR and GCA often occur together
• 10-30% of PMR patients develop GCA
• GCA can cause vision loss
• New headache requires urgent evaluation
• Jaw claudication is warning sign

Treatment

Corticosteroids

• Prednisone is first-line treatment
• Typically 15-20 mg daily initially
• Rapid improvement expected
• Gradual tapering over 1-2 years
• Some need longer treatment

Managing Side Effects

• Bone protection (calcium, vitamin D)
• Monitor for diabetes
• Watch for infections
• Use lowest effective dose

Prognosis

• Most respond well to treatment
• Relapses common during tapering
• Average treatment duration 1-2 years
• Some need longer-term steroids
• Most eventually achieve remission

References

1. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. 2008;372(9634):234-245.
2. Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64(4):943-954.
3. Buttgereit F, Dejaco C, Matteson EL, Dasgupta B. Polymyalgia rheumatica and giant cell arteritis: a systematic review. JAMA. 2016;315(22):2442-2458.