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Polymyalgia rheumatica

Definition

Polymyalgia rheumatica (PMR) is an inflammatory disorder. It involves pain and stiffness in the shoulders and often the hips.

Alternative Names

PMR

Causes

Polymyalgia rheumatica most often occurs in people over 50 years old. The cause is unknown.

PMR may occur before or with giant cell arteritis (GCA; also called temporal arteritis). This is a condition in which blood vessels that supply blood to the head and eye become inflamed.

PMR can sometimes be hard to tell apart from rheumatoid arthritis (RA) in an older person. This occurs when tests for rheumatoid factor and anti-CCP antibody are negative.

Symptoms

The most common symptom is pain and stiffness in both shoulders and the neck. The pain and stiffness are worse in the morning. This pain most often progresses to the hips.

Fatigue is also present. People with this condition find it increasingly hard to get out of bed and to move around.

Other symptoms include:

Exams and Tests

Lab tests alone can't diagnose PMR. Most people with this condition have high markers of inflammation, such as the sedimentation rate (ESR) and C-reactive protein.

Other test results for this condition include:

  • Abnormal levels of proteins in the blood
  • Abnormal level of white blood cells
  • Anemia (low blood count)

These tests may also be used to monitor your condition.

However, imaging tests such as x-rays of the shoulder or hips are not often helpful. These tests may reveal joint damage that is not related to recent symptoms. In difficult cases, ultrasound or MRI of the shoulder may be done. These imaging tests often show bursitis or low levels of joint inflammation. 

Treatment

Without treatment, PMR does not get better. However, low doses of corticosteroids (such as prednisone, 10 to 20 mg per day) can ease symptoms, often within a day or two.

  • The dose should then be slowly reduced to a very low level.
  • Treatment needs to continue for 1 to 2 years. In some people, even longer treatment with low doses of prednisone is needed.

Corticosteroids can cause many side effects such as weight gain, development of diabetes or osteoporosis. You need to be watched closely if you are taking these medicines. If you are at risk for osteoporosis, your health care provider may recommend you take medicines to prevent this condition.

Outlook (Prognosis)

For most people, PMR goes away with treatment after 1 to 2 years. You might be able to stop taking medicines after this point, but check with your provider first.

For some people, symptoms return after they stop taking corticosteroids. In these cases, another medicine such as methotrexate or tocilizumab may be needed.

Giant cell arteritis may also be present or can develop later. If this is the case, the temporal artery would need to be evaluated.

More severe symptoms can make it harder for you to work or take care of yourself at home.

When to Contact a Medical Professional

Call your provider if you have weakness or stiffness in your shoulder and neck that does not go away. Also contact your provider if you have new symptoms such as fever, headache, and pain with chewing or loss of vision. These symptoms may be from giant cell arteritis.

Prevention

There is no known prevention.

References

Dejaco C, Singh YP, Perel P, et al. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67(10):2569-2580. PMID: 2635874 www.ncbi.nlm.nih.gov/pubmed/26352874.

Hellmann DB. Giant cell arteritis, polymyalgia rheumatica, and Takayasu's arteritis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O'Dell JR, eds. Kelley and Firestein's Textbook of Rheumatology. 10th ed. Philadelphia, PA: Elsevier; 2017:chap 88.

Kermani TA, Warrington KJ. Advances and challenges in the diagnosis and treatment of polymyalgia rheumatica. Ther Adv Musculoskelet Dis. 2014;6(1):8-19. PMID: 24489611 www.ncbi.nlm.nih.gov/pubmed/24489611.

Salvarani C, Ciccia F, Pipitone N. Polymyalgia rheumatica and giant cell arteritis. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 166.


Review Date: 1/10/2019
Reviewed By: Gordon A. Starkebaum, MD, MACR, ABIM Board Certified in Rheumatology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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