- Clinical science
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.
- 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!
Epidemiological data refers to the US, unless otherwise specified.
- Systemic symptoms
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
- rheumatoid factor and/or anti-CCP antibodies: positive
- ↑↑ serum creatine kinase (normal in PMR) and
- laboratory values : normal
The differential diagnoses listed here are not exhaustive.
- Low-dose of oral glucocorticoids (alternative: IM glucocorticoids): 12.5–25 mg of oral prednisone daily or 120 mg of IM methylprednisolone every 3 weeks
- If symptoms improve (usually within 2–4 weeks): slowly taper and eventually stop glucocorticoids (reduce to 10 mg prednisone daily within 4–8 weeks)
- No improvement after 2 weeks or relapse: increase dose