From the Guidelines
Polymyalgia Rheumatica (PMR) Definition
Polymyalgia rheumatica (PMR) is a condition characterized by inflammation of the muscles, leading to pain and stiffness in the neck, shoulder, and hip areas 1.
Key Characteristics
- The condition typically affects individuals over the age of 50 and is more common in women than men.
- Symptoms include pain and stiffness in the neck, shoulder, and hip areas, which are typically worse in the morning and improve with activity.
- Systemic inflammation is a key feature of PMR, with elevated levels of inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 1.
- The condition can be associated with giant cell arteritis, a related condition that causes inflammation of the blood vessels.
Diagnosis and Management
- Diagnosis is based on a combination of clinical evaluation, laboratory tests, and imaging studies to exclude other conditions that may mimic PMR 1.
- Treatment typically involves the use of glucocorticoids, such as prednisone, to reduce inflammation and relieve symptoms 1.
- The goal of treatment is to achieve remission, which is defined as the absence of clinical symptoms and systemic inflammation 1.
- Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, may be used in some cases to reduce the dose of glucocorticoids and minimize side effects 1.
Important Considerations
- Comorbidities, such as hypertension, diabetes, and osteoporosis, should be assessed and managed in patients with PMR 1.
- Regular follow-up is necessary to monitor the patient's condition, adjust treatment as needed, and prevent complications 1.
- Patient education and support are essential to help patients manage their condition and improve their quality of life 1.
From the Research
Definition and Characteristics of Polymyalgia Rheumatica (PMR)
- Polymyalgia rheumatica (PMR) is a chronic inflammatory disease that affects the connective vascular tissue, characterized by pain accompanied by morning stiffness, predominantly of the neck muscles, hip and shoulder girdle 2.
- PMR is an inflammatory condition of unknown etiology characterized by aching and stiffness in the shoulder and in the pelvic girdles and neck 3.
- It is one of the most common inflammatory rheumatologic conditions occurring in older adults, typically over 50 years of age, with evidence of an intense systemic inflammatory response 4.
Clinical Symptoms and Diagnosis
- The disease is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle, along with evidence of an intense systemic inflammatory response 4.
- Biological inflammatory syndrome is present with an increase in both the erythrocyte sedimentation rate and C-reactive protein levels 2.
- A normal erythrocyte sedimentation rate does not exclude a diagnosis of PMR, and C-reactive protein and interleukin-6 seem to be more sensitive indicators of disease activity 3.
Treatment and Management
- Corticosteroids are the drugs of choice for treating PMR, with a course of treatment of 1-2 years often required 3.
- Current treatment of PMR consists of low-to-medium doses of glucocorticosteroids (GC) with variable response rates and disease recurrence estimated to occur in 50% of patients while tapering down GC doses 4.
- Large, multicenter, double-blind, placebo-controlled studies are required to define the role of methotrexate and anti-TNF-alpha agents as corticosteroid-sparing drugs in PMR 3.
Outcomes and Prognosis
- Sustained remission in PMR is achievable, with 86.4% of patients achieving sustained remission in a median duration of 9 weeks 5.
- Relapse occurred in 22.1% of patients, primarily due to non-adherence, and medication-free remission was observed in 30.9% of patients 5.
- Damage occurred in 42.0% of patients, highlighting the need for close monitoring and effective management of the disease 5.