From the Guidelines
Yes, polymyalgia rheumatica (PMR) can occasionally cause lower limb weakness, though this is not its most common presentation. PMR typically affects the shoulders, neck, and hips with pain and stiffness rather than true weakness. When lower limb weakness does occur in PMR, it's usually mild and secondary to pain, stiffness, and disuse rather than direct muscle weakness.
Key Considerations
- The standard treatment for PMR is low-dose corticosteroids, typically starting with prednisone 15-20mg daily, which often produces dramatic improvement within days, as suggested by the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations 1.
- This dose is gradually tapered over months to the lowest effective dose.
- If significant lower limb weakness is present, especially if it's asymmetric or progressive, further evaluation is warranted as this could indicate another condition such as giant cell arteritis (a related condition) or another neuromuscular disorder.
- PMR primarily affects people over 50, with inflammation causing the characteristic morning stiffness and pain around the shoulders and hips, which can indirectly lead to perceived weakness as patients limit movement to avoid discomfort.
Management Approach
- The management approach should consider the individual patient's risk factors for glucocorticoid (GC)-related side effects and relapse/prolonged therapy, as outlined in the 2015 EULAR/ACR recommendations 1.
- Methotrexate (MTX) may be considered in addition to GCs, particularly in patients at a high risk for relapse and/or prolonged therapy, as suggested by the 2015 EULAR/ACR recommendations 1.
- An individualised exercise programme may be beneficial for PMR patients to maintain muscle mass and function, and reduce the risk of falls, especially in older persons on long-term GCs, as recommended by the 2015 EULAR/ACR recommendations 1.
From the Research
PMR and Lower Limb Weakness
- The provided studies do not directly address the question of whether PMR can cause lower limb weakness 2, 3, 4, 5, 6.
- However, some studies mention that PMR typically affects the shoulder girdle, neck, and pelvic girdle, which may indirectly suggest that lower limb weakness is not a primary symptom of PMR 3, 5, 6.
- It is worth noting that PMR can cause hip pain, which may be related to lower limb weakness, but this is not explicitly stated in the provided studies 3, 6.
- Further research is needed to determine the relationship between PMR and lower limb weakness, as the current evidence does not provide a clear answer to this question.