Polymyalgia Rheumatica: (PMR)

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Polymyalgia Rheumatica: (PMR)

What is polymyalgia rheumatica?

Polymyalgia rheumatica is a condition involving chronic, diffuse inflammation of the muscles & joints, resulting in pain and stiffness. It is related to another condition called giant cell arteritis, and it is possible to suffer from both conditions simultaneously. About 15 percent of those with polymyalgia rheumatica will develop giant cell arteritis. The neck, shoulders, low back and hips are usually the most commonly affected areas, and symptoms tend to be worse in the mornings.

Who develops polymyalgia rheumatica?

This condition is usually seen in older populations as the majority of cases are seen in those over the age of 65. It is rarely seen in anyone under the age of 50 and if you are under 50 with PMR like symptoms, you may have another condition known as spondylitis; visit this page for more information on spondylitis: https://spondylitis.org/about-spondylitis/types-of-spondylitis/  Women have also been shown to develop the condition more than men. Caucasians are also more prone to developing this disease than other races.

Where does polymyalgia rheumatica occur?

The shoulders and hips are the most common locations that polymyalgia rheumatica can occur. However, other locations on the body can be impacted. They include:

  • Neck
  • Upper arms
  • Buttocks
  • Thighs

Causes

What is the cause of polymyalgia rheumatica?

Polymyalgia rheumatica’s exact cause is not well understood. It is considered an autoimmune disease where the body attacks its healthy tissues. There is a belief that certain genes may place someone at higher risk of developing this condition. Also, there appear to be environmental factors that are linked to developing polymyalgia rheumatica. It is believed that exposure to infections, particularly viruses, may be a cause; however, no specific virus or pathogen can be linked to polymyalgia rheumatica at this time.

What risk factors are there for developing polymyalgia rheumatica?

There are a few risk factors associated with polymyalgia rheumatica and they include:

  • Race - occurs more in white individuals of Scandinavian or northern European descent.
  • Gender -  women are more prone to developing polymyalgia rheumatica than men.
  • Age - this condition is found in older populations and is linked to the aging process. It tends to occur around the ages of 70 to 80.

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Symptoms

What are the symptoms of polymyalgia rheumatica?

Signs and symptoms of polymyalgia rheumatica usually occur suddenly and can even develop overnight. Symptoms tend to occur on both sides of the body and are worst in the morning or after long periods of inactivity. Many describe the symptoms as flu-like symptoms and may last for one to five years. The most common symptoms of polymyalgia rheumatica include: 

  • Muscle achiness
  • Muscle pain
  • Stiffness
  • Fatigue
  • Fever
  • Malaise
  • Loss of appetite
  • Weight loss
  • Depression
  • Insomnia

What complications are associated with polymyalgia rheumatica?

Polymyalgia rheumatica is a serious condition as it can affect you completing simple, daily tasks. Completing minor things such as getting in and out of bed, getting up from a chair, getting dressed, or brushing your hair may all become very difficult to complete on your own.

Diagnosis

How is polymyalgia rheumatica diagnosed?

Diagnosis of polymyalgia rheumatica will involve a history and physical examination and blood tests will be performed to help detect inflammation. Both the sedimentation rate or C-reactive protein will be elevated in polymyalgia rheumatica, but sometimes these levels may be normal. Your healthcare provider will likely also closely monitor you for symptoms of giant cell arteritis as both can occur at the same time.

Treatment

What are treatment options for polymyalgia rheumatica?

Treatment for polymyalgia rheumatica is centered around managing a person’s symptoms, which typically lasts around (6-9) months. Some treatment examples include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)- may be useful in milder cases of polymyalgia rheumatica but are usually ineffective treatment modalities for this condition. Both over the counter and prescription options may be used.
  • Corticosteroids- usually the oral form of corticosteroid in low doses is used for the management of polymyalgia rheumatica. It helps to reduce inflammation and stiffness in the joints associated with this condition, and symptoms tend to respond fairly quickly once medication is initiated. This medication is commonly used for about a year or more so close monitoring from your healthcare specialist will be needed.
  • Disease-modifying antirheumatic drugs (DMARDs)- this form of treatment is recommended to be used in conjunction with corticosteroids or if corticosteroids have not been successful with managing symptoms. It is an oral medication used to suppress the immune system. The most common examples used for polymyalgia rheumatica include:
  1. methotrexate (Trexall)
  • Calcium and Vitamin D supplements- useful with preventing bone loss due to the chronic use of corticosteroids for more than three months.
  • Physical therapy-  an effective treatment for those who may have suffered from prolonged limited mobility due to the disease.
  • Exercise- a useful tool to help keep muscles and joints strong and flexible to reduce inflammation and pain in these areas.

Polymyalgia rheumatica may be a complicated medical condition to diagnose, and other conditions can cause similar symptoms. Luckily, we have several well qualified healthcare providers at TeleMed2U that are capable of helping you effectively treat this disease.

Information

Medically reviewed by:

Dr Roy Kedem, MD

Dr Zenon Andreou studied medicine at University College London, graduating in 2006. His postgraduate training was in hospitals in and around London and he trained for four years in Otolaryngology before completing his training in General practice

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Initial Visit

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