From the Guidelines
Polymyalgia rheumatica (PMR) is characterized by bilateral pain and stiffness in the shoulders, neck, and hip girdle, typically worse in the morning and lasting more than 30 minutes, with laboratory findings showing elevated inflammatory markers, such as erythrocyte sedimentation rate (ESR) usually above 40 mm/hr and C-reactive protein (CRP) also elevated, as supported by the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations 1. The hallmark symptoms of PMR include:
- Bilateral pain and stiffness in the shoulders, neck, and hip girdle
- Systemic symptoms such as low-grade fever, fatigue, weight loss, and malaise
- Difficulty with basic activities like getting out of bed, raising arms overhead, or climbing stairs Laboratory findings typically show:
- Elevated inflammatory markers, with ESR usually above 40 mm/hr and CRP also elevated
- Mild normocytic anemia and thrombocytosis may be present
- Rheumatoid factor and anti-CCP antibodies are typically negative, helping distinguish PMR from rheumatoid arthritis
- Liver function tests may show mildly elevated alkaline phosphatase It's essential to monitor patients for symptoms of giant cell arteritis (headache, jaw claudication, visual disturbances), which can occur in up to 30% of PMR patients and requires immediate treatment to prevent vision loss, as highlighted in the 2015 EULAR/ACR recommendations 1.
From the Research
Hallmark Symptoms of Polymyalgia Rheumatica
- Bilateral proximal aching and morning stiffness in the neck, shoulders, upper arms, lower back, hips, and thighs 2
- Proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50 years of age 3
- Severe pain and stiffness in the neck, shoulder, and pelvic girdles 4
Laboratory Studies
- Erythrocyte sedimentation rate (ESR) higher than 30 or 40 mm/1 hr 2, 4, 5, 6
- Increased levels of C reactive protein (CRP) 4, 6
- Anemia and abnormal protein electrophoresis results may be present in some patients 5
- Note that a normal or slightly increased ESR does not exclude the diagnosis of polymyalgia rheumatica 4, 5