• Clinical science

Polymyalgia rheumatica

Abstract

Polymyalgia rheumatica (PMR) is a common inflammatory rheumatic disease that mainly affects patients above the age of 50 years and occurs twice as often in women than in men. Patients typically present with new-onset pain in their shoulders, hips or neck, morning stiffness, and systemic symptoms (e.g., fatigue, malaise, B symptoms, and depressed mood). In addition to clinical presentation, the diagnosis is made based on laboratory studies, which usually show a highly elevated erythrocyte sedimentation rate (ESR), while creatine kinase and autoantibodies are negative. Bursitis and serositis in the joints of the shoulder and pelvic girdle on ultrasound may also help to confirm the diagnosis. The most important step in the management of PMR is to administer a low dose of oral glucocorticoids and taper them slowly until full remission is achieved. Patients with polymyalgia rheumatica should be routinely monitored for symptoms of giant cell arteritis because this type of vasculitis commonly develops during the course of disease.

Epidemiology

  • Sex: > (2–3:1)
  • Peak incidence: 70–79 years; rarely seen in patients < 50 years
  • More common among individuals of northern European decent
  • Most common inflammatory rheumatic disease in the elderly (second most common overall)

Women of advanced age are particularly prone to the disease!

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

References:[4][1][3]

Clinical features

  • Systemic symptoms
    • Constitutional symptoms: fever, weight loss, night sweats
    • Fatigue and malaise
    • Depressed mood
    • Symptoms of anemia
  • Musculoskeletal symptoms: new onset, symmetric pain
    • Shoulder and pelvic girdle, neck
    • Worse at night
    • Morning stiffness (> 45 min)
    • Subjective weakness
  • ∼ 10–20% of patients with polymyalgia rheumatica also develop typical symptoms of giant cell arteritis

References:[4][3]

Diagnostics

References:[3][5][6]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.

Treatment

References:[7]

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  • 2. Crowson CS, Matteson EL, Myasoedova E, et al. The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis Rheum. 2011; 63(3): pp. 633–639. pmid: 21360492.
  • 3. Docken WP. Clinical Manifestations and Diagnosis of Polymyalgia Rheumatica. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-polymyalgia-rheumatica. Last updated September 4, 2014. Accessed May 9, 2017.
  • 4. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson LJ, Loscalzo J . Harrisons Principles of Internal Medicine . New York, NY: McGraw-Hill Medical Publishing Division; 2016.
  • 5. Ameer F, McNeil J. Polymyalgia rheumatica: clinical update. Aust Fam Physician. 2014; 43(6): pp. 373–6. pmid: 24897986.
  • 6. Kermani TA, Warrington KJ. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Ther Adv Musculoskelet Dis. 2013; 6(1): pp. 8–19. doi: 10.1177/1759720x13512450.
  • 7. Dejaco C, Singh YP, Perel P, et al. Recommendations for the management of polymyalgia rheumatica: A European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2015; 67(10): pp. 2569–2580. doi: 10.1002/art.39333.
  • Seetharaman M. Giant Cell Arteritis (Temporal Arteritis). In: Diamond HS. Giant Cell Arteritis (Temporal Arteritis). New York, NY: WebMD. http://emedicine.medscape.com/article/332483. Updated November 21, 2016. Accessed February 8, 2017.
  • Docken WP, Rosenbaum JT. Clinical Manifestations of Giant Cell (Temporal) Arteritis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-giant-cell-temporal-arteritis. Last updated November 28, 2016. Accessed February 8, 2017.
last updated 11/17/2018
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