Polymyalgia Rheumatica (PMR)

Polymyalgia rheumatica (PMR) refers to the condition in which a person has pain in the muscles of the girdles (hip and shoulder). It is a chronic inflammatory condition of unknown origin and usually affects the elderly. The patient feels pain in the shoulders, arms, neck, and hips accompanied by morning stiffness of around 1 hour or more. Although the pain and stiffness are felt in the muscles, there is no sign of inflammation in the muscle. Instead, the inflammation occurs in the periarticular bursas and tendon insertions. 

Around 15% of people with PMR have a concomitant disorder known as giant cell arteritis, in which blood vessels of the face and scalp become inflamed and cause severe headaches.

It is found more commonly in females. It is diagnosed by clinical symptoms and excluding related disorders. Corticosteroids remain the key agents in the treatment. Although the disease can remit by itself in a few years, medications and self-care help cope with the disease and improve quality of life. 

Still, no specific cause has been identified behind the origin of the disorder. It is thought to result from an interplay of genetic and environmental factors. It sometimes happens after a viral infection suggesting an autoimmune reaction as the initiating phenomenon. It is linked to the HLA-DR4 genetic type. It is often found to occur after cancer therapy. 

In the United States, the prevalence of PMR is about 0.5-0.7%. It affects 52/100,000 people aged 50 years or older per year. The average age at diagnosis is 70 years and females are more prone to get the illness. It is more prevalent in people of Northern European origin.

People having the following factors have shown an inclination towards the illness;

·         People between the ages of 50- 70 years

·         Females

·         Caucasians particularly from Northern Europe

People with PMR may experience the following symptoms;

·         Pain in the shoulders or hips

·         Pain in the muscles of the neck, arms, thighs, etc.

·         Morning stiffness

·         Low-grade fever

·         Weightloss

·         Malaise or fatigue

·         Difficulty getting up from the bed or chair

PMR is a clinical diagnosis which means that the disease is diagnosed based on the clinical symptoms of the patients. There are no specific tests for PMR. Blood tests are done to exclude the possibility of similar disorders.

History and Examination: When you will visit your healthcare provider he will obtain a detailed history regarding the pain, its onset, associated symptoms, previous medical history, and family history. He will then perform a physical examination with a special focus on the muscles and the joints.

Blood tests: Your blood can be taken for evaluation of blood cells (CBC), Electrolytes, Blood glucose, Liver function tests, ESR, and CRP. Some important parameters are checked in the blood to exclude other diseases. They include rheumatoid factor (Rf) and Anti-CCP antibodies, which will be negative in the case of PMR.

Imaging Studies: Radiographs will not show any specific features. MRI scans are usually not required but they can show inflammation in the bursas and tendon sheaths of the girdles and hands/ feet.

The features that are typical of PMR include;

·         Age: 50 years or older

·         A high Erythrocyte sedimentation rate (ESR)

·         Persistent pain in at least two regions (neck, shoulders, hips) for more than a month

·         Absence of other related diseases

·         Morning stiffness lasting for more than 1 hour

·         Rapid improvement after giving corticosteroids

PMR can resemble many diseases involving muscles and joints like;

·         Osteoarthritis

·         Rheumatoid Arthritis (RA)

·         Polymyositis

·         Fibromyalgia

·         Depression

·         Giant Cell Arteritis

·         Hypothyroidism

·         Multiple Myeloma

·         Paraneoplastic Syndromes

Polymyalgia rheumatica (PMR) is a long-lasting disorder that often subsides on its own. However, the results of several trials have brought to light some treatment regimes that can abate the troubling symptoms and improve the quality of life.

Corticosteroids (ie, prednisone) remain the treatment of choice. Rapid response to the treatment has been observed with the improvement of clinical symptoms and curtailment of ESR levels. The dose and duration of the steroids are decided considering the weight of the patient and the severity of the symptoms. Usually, symptoms improve within 3-4 days or up to a week. If not so, then some other disorder may need to be looked for. Therapy is mostly given for 2-3 years after which the dose of steroids should be tapered off according to the remission of symptoms. 

Although PMR causes considerable discomfort, patients can lead a normal life if timely treatment and lifestyle changes are adopted. 

To cope with the disease, following lifestyle changes must be adopted to have a peaceful life.

·         Diet Improvement: A person is advised to take a healthy balanced diet that must have vitamins, minerals, amino acids, and antioxidants, along with supplementation of calcium and Vitamin D.

·         Physical therapy: For people with persistent stiffness and pain despite medications, physical therapy will be beneficial.  

·         Exercises: A person is advised to perform some form of moderate exercise to improve stiffness and activity.

·         Psychological therapies: Some people develop depression because of their pain. They may need to consult a psychologist to cope with it.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 08, 2023.

References

https://www.nhs.uk/conditions/polymyalgia-rheumatica/#:~:text=Polymyalgia%20rheumatica%20(PMR)%20is%20a,the%20shoulders%2C%20neck%20and%20hips.

https://www.versusarthritis.org/about-arthritis/conditions/polymyalgia-rheumatica-pmr/