What are the signs and symptoms of Polymyalgia Rheumatica (PMR)?

From the Guidelines

Polymyalgia rheumatica (PMR) is characterized by bilateral pain and stiffness in the shoulders, neck, and hip girdle, accompanied by systemic symptoms such as fatigue, low-grade fever, weight loss, and general malaise, with laboratory findings showing elevated inflammatory markers, particularly erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) 1. The condition predominantly affects adults over 50 years of age, with increasing prevalence in older populations. Key features of PMR include:

• Bilateral pain and stiffness in the shoulders, neck, and hip girdle, especially pronounced in the morning or after periods of inactivity
• Systemic symptoms such as fatigue, low-grade fever, weight loss, and general malaise
• Elevated inflammatory markers, particularly ESR and CRP
• Absence of actual muscle weakness, distinguishing it from other inflammatory muscle diseases
• Potential development of giant cell arteritis, a related inflammatory condition affecting large blood vessels, presenting with headache, jaw claudication, and visual disturbances 1. The diagnosis of PMR is primarily clinical, with prompt medical evaluation important to initiate treatment with low-dose corticosteroids, typically prednisone 12.5-25mg daily, which usually provides dramatic symptom relief within days, serving as a diagnostic criterion 1.

From the Research

Signs and Symptoms of PMR

• The signs and symptoms of Polymyalgia Rheumatica (PMR) can be complex and varied, but some common indicators include chronic pain in the shoulder and hip girdle, elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, and systemic signs and symptoms such as fever and weight loss 2.
• However, some patients may present with normal ESR and CRP values at the time of diagnosis, making diagnosis more challenging 3, 2.
• In these cases, other diagnostic tools such as ultrasound and 18-fluorodeoxyglucose positron emission tomography associated with total body computed tomography (18-FDG PET/CT) may be useful in confirming the diagnosis of PMR 3.
• The clinical features of patients with PMR and normal ESR at diagnosis or during relapse/recurrence can vary, but may include lower CRP levels and more frequent systemic signs and symptoms 2.
• ESR and CRP can be useful in assessing PMR activity, but ESR may be a superior predictor of relapse than CRP 2.
• The diagnosis of PMR should be considered even in patients with normal inflammatory indices, especially if they present with chronic bilateral shoulder and hip girdle pain 3.

Diagnostic Considerations

• A diagnosis of PMR should be based on a combination of clinical features, laboratory results, and imaging studies 3, 2.
• The presence of elevated ESR and CRP levels can support a diagnosis of PMR, but normal values do not rule out the condition 3, 2.
• Other conditions that may present with similar symptoms should be considered in the differential diagnosis, and a thorough evaluation should be conducted to confirm the diagnosis of PMR 3, 2.

Laboratory Tests

• ESR and CRP are commonly used laboratory tests to evaluate disease activity and severity in PMR 2.
• ESR may be a more sensitive indicator of disease activity than CRP, but CRP can be a useful marker of current disease activity 2.
• Other laboratory tests, such as phenotypic analysis of lymphocyte subpopulations, may also be useful in evaluating PMR patients 2.