An Overview of Polymyalgia Rheumatica

The American College of Rheumatology (ACR), in collaboration with the European League Against Rheumatism (EULAR), released classification criteria for polymyalgia rheumatica (PMR) in March 2012. Prior to release of the criteria, there were no well-established or well-tested criteria to identify patients with PMR.

Symptoms

PMR is a rheumatic condition with characteristic musculoskeletal pain and stiffness in the neck, shoulders, and hips that lasts for at least four weeks. For most people, PMR develops gradually, although some can develop symptoms very quickly.

Besides musculoskeletal stiffness, symptoms of PMR may include systemic flu-like effects such as fever, malaise, weakness, and weight loss.

Diagnosis and Identification

The diagnosis of PMR is based on your medical history, clinical signs and symptoms, and a physical examination. There is no single blood test to definitively diagnose PMR. Your healthcare provider might order blood tests to identify elevated levels of inflammatory markers (e.g., sedimentation rate or CRP) or to rule out other types of arthritis.

Under the classification criteria released by ACR and EULAR, a patient may be classified as having PMR if they are 50 years old or older, have bilateral shoulder aching, and abnormal blood CRP or sedimentation rate, plus certain combinations of the following criteria:

• Morning stiffness lasting 45 minutes or more
• New-onset hip pain or limited range of motion
• No swelling in small joints of hands and feet
• No positive blood tests for rheumatoid arthritis (e.g., rheumatoid factor or anti-CCP antibodies)

The classification criteria were actually not created to be a diagnostic protocol, but rather to help with the selection of patients for clinical trials and to develop new therapies to treat PMR.

Treatment

Without treatment, PMR symptoms are likely to persist for months or years.

PMR is treated with a low dose of corticosteroid medication. Healthcare providers prescribe and adjust the dose of steroids (usually prednisone) to achieve the lowest effective dose, which is typically between 15 and 20 mg daily. Usually, stiffness associated with PMR is relieved within three days.

Patients typically need to continue to use steroids for six to 12 months, often at lower doses than initially prescribed. Most people who have PMR are able to stop corticosteroid medications after taking them for a duration ranging between six months to two years.

If symptoms recur, which often happens, corticosteroids can be restarted.

Nonsteroidal anti-inflammatory medications (NSAIDs) can also be used to treat PMR, but usually, when taken alone, they are not enough to control symptoms.

Prevalence

Women who are Caucasian and over age 50 have the highest risk of developing PMR or giant cell arteritis (a related condition). In the United States, it is estimated that approximately 700 per 100,000 people over age 50 in the general population have PMR. It is very rare for someone under 50 years old to develop PMR.

Associated Conditions

Patients with PMR have an increased risk of being affected by giant cell arteritis. This is a type of arthritis caused by inflammation of large blood vessels, and it may be associated with serious complications—such as blindness or stroke.

Signs and symptoms of this disorder include, but are not limited to, headaches (typically on one or both sides of the temples or behind the head), visual changes such as blurred or diminished vision, scalp tenderness, jaw fatigue with chewing, tongue pain, or fever.

If you have been diagnosed with PMR, let your healthcare provider know if you currently have or develop these symptoms so you can have the necessary additional testing. If you have giant cell arteritis, you might need higher doses of steroids or other medications to help control it and to prevent serious complications.

PMR affects the same patient population as giant cell arteritis, but PMR occurs two to three times more frequently than giant cell arteritis. Both PMR and giant cell arteritis are classified as vasculitides (a group of conditions characterized by inflammation of the blood vessels).