From the Guidelines
Yes, polymyalgia rheumatica (PMR) can be related to chest pain, though it's not among the most common symptoms. PMR primarily causes pain and stiffness in the shoulders, neck, and hips, but in some cases, it can affect the chest wall muscles, leading to chest pain. This chest pain is typically muscular in nature and may worsen with movement or deep breathing. It's essential to distinguish PMR-related chest pain from cardiac chest pain, as the symptoms can sometimes be confused. According to the 2015 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) recommendations for the management of PMR 1, therapy for PMR varies widely in clinical practice, and international recommendations for PMR treatment are not currently available. However, the recommendations suggest that PMR is typically treated with low-dose corticosteroids, usually starting with prednisone at 12.5-25mg daily, which often provides dramatic relief within days. The dose is then gradually tapered over months to years. If you experience chest pain along with other PMR symptoms like morning stiffness, shoulder and hip pain, fatigue, and weight loss, especially if you're over 50, consult a healthcare provider promptly. They may check inflammatory markers like ESR and CRP, which are typically elevated in PMR, as mentioned in the 2015 recommendations for the management of PMR 2. Remember that chest pain can have many causes, so proper medical evaluation is essential to rule out serious conditions like heart disease.
Some key points to consider when evaluating PMR-related chest pain include:
- The patient's age, as PMR is more common in individuals over 50
- The presence of other PMR symptoms, such as morning stiffness, shoulder and hip pain, fatigue, and weight loss
- The results of inflammatory marker tests, such as ESR and CRP
- The patient's response to low-dose corticosteroid treatment, as recommended by the 2015 EULAR/ACR guidelines 3.
It's crucial to prioritize a thorough medical evaluation to determine the underlying cause of chest pain and to develop an effective treatment plan.
From the Research
Relationship between Polymyalgia Rheumatica and Chest Pain
- Polymyalgia rheumatica (PMR) is an inflammatory disorder that can present with various symptoms, including chest pain, as seen in a case report where a patient with PMR initially presented with chest pain, pleural, and pericardial effusions 4.
- The study from 2016 provides an overview of PMR and giant cell arteritis (GCA), discussing their clinical features, diagnosis, and treatment, but does not specifically address chest pain as a symptom of PMR 5.
- Another study from 2022 mentions that PMR can cause general symptoms such as fatigue, fever, and weight loss, but does not explicitly link PMR to chest pain 6.
- A case report from 2005 highlights the importance of considering PMR in the differential diagnosis of pleuropericardial effusions, which can cause chest pain 4.
- The relationship between PMR and chest pain is further supported by a study from 2018, which discusses the long-term treatment of PMR and GCA with glucocorticoids, but does not directly address chest pain as a symptom 7.
- A review from 2023 discusses current treatment approaches and new therapeutic targets for GCA and PMR, but does not specifically mention chest pain as a symptom of PMR 8.
Key Findings
- PMR can present with chest pain, pleural, and pericardial effusions, as seen in a case report 4.
- The diagnosis of PMR is based on clinical features, such as new-onset bilateral shoulder pain, and elevated inflammatory markers 5.
- Glucocorticoids are the primary treatment for PMR, but the optimal initial dose and tapering treatment regimens are unknown 5.
- Methotrexate may be added to glucocorticoids in patients at risk for relapse and in those with glucocorticoid-related adverse effects or need for prolonged glucocorticoid therapy 5.