Polymyalgia rheumatica (PMR) is a relatively common cause of widespread aching and stiffness in older adults. PMR can overlap with another rheumatic disease called giant cell arteritis, and symptoms of the two conditions can occur at the same time or separately. (See p. 12 of the March 2008 issue for more on giant cell arteritis.) The typical symptoms of PMR include aching and stiffness around the upper arms, neck, lower back, buttocks, and thighs. Symptoms tend to develop quickly over a period of several days or weeks, and occasionally even overnight.
PMR occurs only in older adults. The average age of symptom onset is 70, and many people who have PMR are 80 or older. Women are affected somewhat more often than men. The disease is more frequent in whites than other races, but all races are susceptible. PMR is not unusual—in fact, it is diagnosed for the first time in older adults more frequently than RA.
The cause of PMR is unknown. The tendency for symptoms to begin abruptly suggests the possibility of an infection but, so far, no specific infection has been found. According to patient–fact sheet writer William Docken, MD, “recent evidence now suggests that PMR is an arthritis with a particular tendency to involve the shoulder and hip joints, and the bursae (or sacs) around these joints. Thus, the pain in the upper arms and thighs comes from the nearby shoulder and hip joints.” Symptoms of PMR are usually worse at night and when first rising in the morning.
Rheumatologists use blood tests to diagnose PMR. The blood tests may show abnormally increased inflammation, but in a small proportion of patients, these tests may be normal or only slightly increased. If PMR is strongly suspected, a trial of low-dose corticosteroids is given, usually in the form of 10–15 mg of prednisone per day.
If PMR is present, these medications will control the pain quickly. The response to corticosteroids can be dramatic; some patients are better after only one dose and (once stiffness has subsided) normal activities can be resumed, including exercise as tolerated. However, if symptoms have not been completely relieved after two to three weeks of treatment, other diagnoses should be considered.
Download the complete PMR fact sheet and other patient education materials at www.rheumatology.org by following the links to patient education from the Practice Support menu.
