Polymyalgia Rheumatica

(PMR)
  • Definition

    Polymyalgia rheumatica (PMR) is an inflammatory disorder. It results in muscle pain and stiffness in the body. The effects are most common in the shoulders, arms, hips, and thighs. About 15% of people with PMR will also develop giant cell arteritis (GCA). GCA is an inflammation of the lining of the arteries, the blood vessels that carry blood away from the heart.
    Giant Cell Arteritis
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  • Causes

    The exact cause is not known. Inflammatory conditions may be due to some problem with the immune system. Some evidence suggests that certain viruses could be responsible for PMR. Genetic factors may also play a role.
  • Risk Factors

    PMR is most common in Caucasian women, aged 65 years and older.
  • Symptoms

    Symptoms may include:
    • Muscle pain and/or stiffness in the hip, shoulder, or neck areas
    • Stiffness in the morning
    • Fever
    • Unexplained weight loss
    • Fatigue
    • Mood changes
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. There is no single test for PMR. To support the diagnosis and rule out other conditions, tests may include:
    • Erythrocyte sedimentation rate (ESR), a blood test that measures how quickly red blood cells fall to the bottom of a test tube.
    • Rheumatoid factor (RF), a blood test that looks for RF antibodies in the blood.
    • Complete blood count, a blood test that measures the amount of different blood cells present in whole blood.
    • C-reactive protein, a protein that is elevated in the blood when inflammation is present.
    • Muscle biopsy.
    Imaging studies take pictures of internal body structures. These may include CT scan or MRI.
    If you have PMR, your doctor may also consider the possibility of GCA. Evaluation for GCA includes:
    • Physical exam, including vision test
    • Biopsy of an affected blood vessel is necessary to confirm the diagnosis
  • Treatment

    Symptoms of PMR will disappear without treatment within several months to years. Treatment leads to dramatic improvement, which may occur within 24-48 hours.
    Treatment may include:
    • Anti-inflammatory medications
    • Corticosteroids
    • Supplements, such as calcium or vitamin D
    • Physical therapy to help with strength, flexibility, and mobility
  • Prevention

    There are current guidelines to prevent PMR.
  • RESOURCES

    American College of Rheumatology http://www.rheumatology.org

    Arthritis Foundation http://www.arthritis.org

    CANADIAN RESOURCES

    The Arthritis Society http://www.arthritis.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Brooks RC, McGee SR. Diagnostic dilemmas in polymyalgia rheumatica. Arch Intern Med. 1997;157:1162.

    Eberhardt RT, Dhadly M. Giant cell arteritis: diagnosis, management, and cardiovascular implications. Cardiol Rev. 2007;15(2):55-61.

    Matteson EL, Gold KN, et al. Long-term survival of patients with giant cell arteritis in the American College of Rheumatology Giant Cell Arteritis classification criteria cohort. Am J Med. 1996;100:193.

    Polymyalgia rheumatica. American College of Rheumatology website. Available at: http://www.rheumatology.org/practice/clinical/patients/diseases%5Fand%5Fconditions/polymyalgiarheumatica.asp. Updated February 2013. Accessed June 26, 2013.

    Polymyalgia rheumatica. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated January 16, 2013. Accessed June 26, 2013.

    Polymyalgia Rheumatical and giant cell arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Polymyalgia/default.asp. Accessed June 26, 2013.

    Salvarani C, Cantini F, et al. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347:261.

    Soubrier M, Dubost JJ, et al. Polymyalgia rheumatica: diagnosis and treatment. Joint Bone Spine. 2006;73(6):599-605. Review.

    Temporal arteritis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated September 18, 2012. Accessed June 26, 2013.

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