What is Polymyalgia Rheumatica (PMR)?

From the Guidelines

Polymyalgia rheumatica (PMR) is an inflammatory disorder characterized by muscle pain and stiffness, primarily affecting the shoulders, hips, and neck in adults over 50, and its management involves a combination of glucocorticoid therapy, disease modifying anti-rheumatic drugs, and non-pharmacological interventions, as recommended by the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) collaborative initiative 1. The diagnosis and treatment of PMR can be complex, and the 2015 EULAR/ACR recommendations provide a framework for the management of PMR, including basic and follow-up investigations, risk factor assessment, and treatment strategies such as initial glucocorticoid doses and subsequent tapering regimens 1. Some key aspects of PMR management include:

• Initial glucocorticoid doses and subsequent tapering regimens
• Use of intramuscular glucocorticoids and disease modifying anti-rheumatic drugs (DMARDs)
• Roles of non-steroidal anti-rheumatic drugs and non-pharmacological interventions
• Regular monitoring of symptoms, inflammatory markers, and potential steroid side effects The exact cause of PMR remains unknown, but it likely involves genetic and environmental factors triggering an abnormal immune response in older adults. The 2015 EULAR/ACR recommendations emphasize the importance of a comprehensive approach to PMR management, taking into account the quality of evidence, the balance between desirable and undesirable effects, patients’ and clinicians’ values and preferences, and resource use 1.

From the Research

Definition and Characteristics of Polymyalgia Rheumatica (PMR)

• PMR is an inflammatory condition that primarily affects individuals aged 50 and older, especially in Western countries 2.
• It is characterized by acute or subacute bilateral shoulder pain with severe stiffness and often neck and bilateral hip pain 3.
• PMR is the most common autoimmune inflammatory disease in older persons with an average age of onset of 73 years 3.
• Giant cell arteritis (GCA) occurs in approximately 20% of cases and up to two thirds of patients with GCA have symptoms of PMR 3.

Diagnosis of PMR

• There are no specific laboratory tests for PMR, but C-reactive protein and erythrocyte sedimentation rates are elevated in over 90% of patients 3.
• The diagnosis may be aided by imaging, especially ultrasonography and magnetic resonance imaging (MRI) 3, 4.
• Elderly onset rheumatoid arthritis is frequently misdiagnosed as PMR, and other conditions may mimic PMR 3.

Treatment of PMR

• Glucocorticoids, such as prednisone or prednisolone, are the cornerstone of PMR treatment, with an initial dose of 12.5-25 mg/day 2, 3.
• Treatment duration is typically 2-3 years but may be longer 3.
• Methotrexate is the most commonly used corticosteroid-sparing agent 2, 4, 5.
• Biologic agents, such as anti-IL-6 receptor agents, have demonstrated efficacy in reducing relapse frequency and achieving long-term remission of the disease 2.