Can polymyalgia rheumatica (PMR) exacerbation cause fever?

From the Guidelines

Yes, polymyalgia rheumatica (PMR) exacerbations can sometimes cause fever, though it's not among the most common symptoms. During a flare-up, patients typically experience more pronounced stiffness and pain in the shoulders, neck, and hips, with fever occurring in approximately 15-30% of cases. When fever is present in PMR, it's usually low-grade (below 101°F or 38.3°C). However, persistent or high-grade fever should raise concerns about alternative diagnoses, particularly giant cell arteritis (GCA), which is closely related to PMR and can cause more significant fevers.

Key Considerations

• If you experience fever during what seems to be a PMR flare, contact your healthcare provider promptly, as this might indicate either a more severe exacerbation requiring adjustment of your corticosteroid dose (typically prednisone 10-20 mg daily for PMR) or the development of GCA, which requires immediate higher-dose treatment (typically prednisone 40-60 mg daily) to prevent serious complications like vision loss 1.
• The inflammatory nature of PMR, characterized by elevated inflammatory markers like ESR and CRP, explains why some patients develop fever during exacerbations, as these inflammatory cytokines can affect the body's temperature regulation.
• According to the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of PMR, patients should have an individualized management plan, and treatment should aim at the best care based on a shared decision between the patient and the treating physician 1.

Monitoring and Treatment

• Patients should have access to education focusing on the impact of PMR and treatment, including comorbidities and disease predictors, and advice on individually tailored exercise programs 1.
• Every patient treated for PMR should be monitored with assessments for risk factors and evidence of steroid-related side effects, comorbidities, other relevant medications, and evidence and risk factors for relapse/prolonged therapy 1.
• The role of risk factors for relapse/prolonged therapy is not clear yet, but baseline factors associated with a higher relapse rate and/or prolonged therapy in PMR studies were female sex, high ESR (>40 mm/1st hour), and peripheral inflammatory arthritis 1.

From the Research

Polymyalgia Rheumatica Exacerbation and Fever

• Polymyalgia rheumatica (PMR) is a chronic, inflammatory disorder characterized by pain and stiffness in the neck, shoulders, hips, upper arms, and thighs 2.
• The condition is often associated with elevated markers of inflammation, such as C-reactive protein and erythrocyte sedimentation rates 3.
• While the exact cause of PMR is unknown, it is believed to be related to an intense systemic inflammatory response 4.
• Exacerbation of PMR can lead to increased inflammation, which may manifest as fever, among other symptoms.
• However, the provided studies do not directly address the relationship between PMR exacerbation and fever 5, 4, 6, 3, 2.
• Treatment of PMR typically involves low-dose glucocorticoids, which can provide symptomatic relief but may also be associated with substantial morbidity 2.
• Other treatment options, such as methotrexate and anti-interleukin-6 receptor antibodies, may also be used to manage the condition 6.

Inflammatory Response and Fever

• The inflammatory response associated with PMR can lead to a range of symptoms, including fever, fatigue, and malaise 4.
• Elevated markers of inflammation, such as C-reactive protein, are common in PMR and can indicate the presence of an inflammatory response 3.
• However, the provided studies do not specifically address the relationship between PMR exacerbation and fever.

Treatment and Management

• Treatment of PMR typically involves a combination of pharmacologic and non-pharmacologic interventions 5, 4, 6, 3, 2.
• Low-dose glucocorticoids are commonly used to manage the condition, but may be associated with substantial morbidity 2.
• Other treatment options, such as methotrexate and anti-interleukin-6 receptor antibodies, may also be used to manage the condition 6.