From the Guidelines
Polymyalgia rheumatica (PMR) primarily manifests as bilateral pain and stiffness in the shoulders, neck, and hip girdle, typically worse in the morning and lasting more than 30 minutes, as noted in the most recent study 1.
Clinical Presentation
The clinical presentation of PMR includes:
- Bilateral pain and stiffness in the shoulders, neck, and hip girdle
- Morning stiffness lasting more than 30 minutes
- Difficulty with everyday activities like getting out of bed, rising from a chair, or raising their arms above shoulder level
- Systemic symptoms such as fatigue, low-grade fever, weight loss, and malaise
- Limited range of motion in affected areas due to pain rather than true weakness, with minimal or no synovitis
Laboratory Findings
Laboratory findings typically show elevated inflammatory markers (ESR and CRP), often above 40 mm/hr for ESR, as well as anemia of chronic disease and thrombocytosis 1.
Diagnosis and Treatment
The diagnosis of PMR is primarily clinical, supported by rapid response to low-dose glucocorticoids (10-20 mg prednisone daily), which typically produces dramatic improvement within 24-72 hours, as recommended in the most recent guideline 1.
Key Points
- PMR predominantly affects adults over 50 years of age, with increasing incidence in older populations, and women are affected more frequently than men
- About 15-30% of PMR patients may have associated giant cell arteritis, presenting with headache, jaw claudication, or visual disturbances, which requires immediate medical attention to prevent vision loss
- Early referral to a rheumatologist should be considered in cases of insufficient response to acceptable doses of CS and in cases requiring CS-sparing regimens, as noted in the study 1
From the Research
Clinical Manifestations of PMR
- Bilateral proximal aching and morning stiffness in the neck, shoulders, upper arms, lower back, hips, and thighs 2
- Acute or subacute bilateral shoulder pain with severe stiffness and often neck and bilateral hip pain 3
- Inflammatory pain involving the shoulder girdle and less commonly the neck and pelvic girdle 4
- Bilateral shoulder and hip stiffness that is worse in the morning and improves with use 5
Associated Symptoms
- Constitutional symptoms 5
- Nonspecific musculoskeletal complaints 5
- Elevated serum inflammatory markers 5
- Giant cell arteritis (GCA) occurs in approximately 20% of cases 3