Polymyalgia Rheumatica: Symptoms, Diagnosis and Treatment

Polymyalgia Rheumatica (PMR) is an inflammatory disease, leading to generalized muscle pain and stiffness. This disease is associated with giant cell arteritis (GCA), a condition involving inflammation of large to medium-sized arteries presenting with a severe headache. It is thought that PMR and GCA are at different points of the same disease spectrum.

PMR occurs almost exclusively in individuals over the age of 50 years. It is quite common, with a prevalence of 700 per 100,000 in one study in Olmstead County, Minnesota where the population is predominantly of Scandinavian descent. About 10 to 20% of individuals with PMR develop GCA as well.

Symptoms of Polymyalgia Rheumatica

• Muscle aches in the region around the hips, shoulders, and neck.
• Stiffness in the muscles, especially in the mornings and after periods of inactivity
• Tenderness in the muscle may also be present
• Fatigue
• Weight loss and loss of appetite
• Low-grade fever
• Depression

Diagnosis of Polymyalgia Rheumatica

The diagnosis is based on the history of pain and stiffness in the muscles. Additional lab tests help to confirm the diagnosis.

• Complete blood count: This reveals anemia
• Erythrocyte Sedimentation Rate (ESR): this is a marker of inflammation and is elevated to very high levels in PMR
• Blood tests to look for makers of other immunologic disorders: These tests are usually negative

Complications of Polymyalgia Rheumatica

A subset of patients with PMR may develop GCA. GCA presents with a severe headache in the temples from inflammation of the large vessels in the head such as the carotid arteries and temporal arteries. This may progress to cause vision disturbance and even blindness. It is important to rule out GCA in patients with PMR at the time of diagnosis.

Treatment of Polymyalgia Rheumatica

• The treatment of patients with polymyalgia rheumatic alone is low dose steroids. This brings about prompt relief of symptoms.
• The duration of steroid therapy is determined by the response. Symptomatic relief is followed by a slow, gradual tapering of the dose until stopped
• During therapy, the ESR is monitored. A fall in ESR indicates a response to treatment
• High dose steroids are required in the treatment of GCA if present alongside PMR

Prognosis of Polymyalgia Rheumatica

This can be managed effectively with steroids. Often, the disease returns upon stopping steroid therapy and longer durations of treatment may be required. It is important to monitor patients with PMR for the development of GCA with provision for quick management to prevent complications.

References:

• Crowson CS, Matteson EL. Contemporary prevalence estimates for giant cell arteritis and polymyalgia rheumatica, 2015. Semin Arthritis Rheum. 2017 Oct;47(2):253–6.
• Dejaco C, Singh YP, Perel P, Hutchings A, Camellino D, Mackie S, et al. 2015 Recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Ann Rheum Dis. 2015 Oct;74(10):1799–807.