Can Polymyalgia Rheumatica (PMR) cause finger swelling?

Can Polymyalgia Rheumatica (PMR) Cause Finger Swelling?

Yes, polymyalgia rheumatica (PMR) can cause finger swelling with pitting edema, which is considered a peripheral manifestation of the disease. While PMR primarily affects the shoulder and pelvic girdles, distal extremity swelling including finger swelling has been documented as a clinical feature of PMR.

Clinical Presentation of PMR and Peripheral Manifestations

• PMR typically presents with pain and morning stiffness in the shoulder and pelvic girdle, with acute or gradual onset over days to weeks 1
• While the classic symptoms involve proximal muscles, PMR can also manifest with peripheral symptoms including swelling of the hands and knees 2
• Distal extremity swelling with pitting edema represents a manifestation of PMR that occurs in a subset of patients 3
• This swelling can affect both upper and lower extremities, often in a symmetric manner 3

Evidence for Finger Swelling in PMR

• PMR can present with "possible swelling of the hands and knees" as noted in clinical guidelines 2
• Diffuse distal extremity swelling with pitting edema has been documented in PMR patients, with both upper and lower extremities affected 3
• In a study of 245 PMR patients over a 22-year period, 19 patients (approximately 8%) exhibited episodes of distal extremity swelling with pitting edema 3
• This swelling appears to represent tenosynovitis and synovitis of regional structures 3

Timing of Finger Swelling in PMR

• Distal swelling can occur at different stages of PMR:
  • Concurrently with the onset of proximal PMR symptoms (most common) 3
  • As the initial manifestation of PMR (less common) 3
  • During relapses or recurrences of PMR 3

Differential Diagnosis

• When finger swelling is present, it's important to rule out other conditions that can mimic PMR, including:
  • Rheumatoid arthritis, particularly elderly-onset rheumatoid arthritis (EORA) 4
  • Giant cell arteritis (GCA), which can overlap with PMR 4
  • Other inflammatory arthritides 2
  • Infections or malignancies 4

Diagnostic Approach for PMR with Finger Swelling

• Diagnostic evaluation should include:
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 2
  • Rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies to exclude rheumatoid arthritis 2
  • Creatine kinase (CK) level to rule out myositis 2
  • X-rays and ultrasound of affected joints 2
  • Evaluation for giant cell arteritis, which can coexist with PMR 2

Treatment Response

• The distal swelling and pitting edema in PMR typically responds promptly to corticosteroid therapy 3
• Response to glucocorticoids can help confirm the diagnosis of PMR 3
• NSAIDs alone may provide incomplete relief for the swelling 3
• Standard PMR treatment with glucocorticoids (15-25 mg prednisone equivalent daily) is recommended 5

Clinical Implications

• Recognition of finger swelling as a potential manifestation of PMR is important for accurate diagnosis 3
• Atypical presentations of PMR, including peripheral inflammatory arthritis, may warrant specialist referral 2
• Peripheral manifestations may be associated with a higher risk of relapse and/or prolonged therapy in PMR 2
• Prompt treatment with appropriate doses of glucocorticoids is essential for symptom relief 3

Understanding that finger swelling can be part of the clinical spectrum of PMR helps clinicians make accurate diagnoses and initiate appropriate treatment, avoiding unnecessary investigations or incorrect management approaches.