From the Research
Polymyalgia rheumatica (PMR) typically develops over a period of several weeks to months, but the most recent and highest quality study suggests that 98.8% of patients achieve symptom control in a median duration of 3 weeks 1. The onset of PMR can be acute or develop over a few days to weeks, with the most common symptoms being pain and morning stiffness in the shoulder and pelvic girdle [ 2, 3, 4 ]. Some studies suggest that the onset may be more rapid, with patients experiencing a rapid response to treatment in less than a week [ 2, 3 ]. However, the majority of patients describe their symptoms as worsening steadily over 1-3 months before seeking medical attention [ 5, 4 ]. The slow onset reflects the underlying pathophysiology of PMR, which involves a chronic inflammatory process affecting the synovial tissues and bursae around large joints, particularly in the shoulder and pelvic girdles. Key factors to consider in the diagnosis of PMR include:
- The typical age of presentation (usually over 50 years)
- Elevated inflammatory markers
- The characteristic pattern of onset
- The presence of morning stiffness and pain in the shoulders, neck, and hip girdle areas
- The absence of specific laboratory or radiographic findings, although some consider an elevated sedimentation rate (> 50 mmg/hr) to be essential to diagnosis [ 5 ]. It is essential to distinguish PMR from other inflammatory conditions that may have more acute presentations, and to consider the potential for giant cell arteritis, which may complicate the disease course and require more intense and prolonged treatment [ 4 ].