by Badash M

Polymyalgia Rheumatica

(PMR)

Definition

Polymyalgia rheumatica (PMR) is an inflammatory disorder. It results in muscle pain and stiffness in the body. The effects are most common in the shoulders, arms, hips, and thighs. About 15% of people with PMR will also develop giant cell arteritis (GCA). GCA is an inflammation of the lining of the arteries, the blood vessels that carry blood away from the heart.
Giant Cell Arteritis
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Causes

The exact cause is not known. Inflammatory conditions may be due to some problem with the immune system. Some evidence suggests that certain viruses could be responsible for PMR. Genetic factors may also play a role.

Risk Factors

PMR is most common in Caucasian women, aged 65 years and older.

Symptoms

Symptoms may include:
  • Muscle pain and/or stiffness in the hip, shoulder, or neck areas
  • Stiffness usually occurs in the morning or after long rests and may ease throughout the day
  • Fever
  • Unexplained weight loss
  • Fatigue
  • Mood changes
Symptoms that may indicate temporal arteritis may include:
  • Headache
  • Jaw pain
  • Scalp tenderness
  • Visual changes

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. PMR will be suspected if symptoms are there for more than 2-4 weeks.
Your bodily fluids or tissue may be tested. This can be done with:
  • Blood tests—which show presence of inflammation
  • Muscle biopsy
  • Temporal artery biopsy, if suspected
Images may be taken of your bodily structures. This can be done with:

Treatment

Symptoms of PMR may disappear without treatment within several months to years, but treatment leads to dramatic improvement. Relief may occur within 24-48 hours.
Treatment may include:
  • Corticosteroids—may be used for up to 2 years at low doses
  • Supplements, such as calcium or vitamin D and biphosphonates—to prevent bone loss due to steroid treatment
  • Physical therapy to help with strength, flexibility, and mobility
  • Anti-inflammatory medications

Prevention

There are current guidelines to prevent PMR.

RESOURCES

American College of Rheumatology
http://www.rheumatology.org
Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES

The Arthritis Society
http://www.arthritis.ca
Health Canada
http://www.hc-sc.gc.ca

References

Polymyalgia rheumatica. American College of Rheumatology website. Available at: http://www.rheumatology.org/practice/clinical/patients/diseases%5Fand%5Fconditions/polymyalgiarheumatica.asp. Updated June 2015. Accessed May 11, 2016.
Polymyalgia rheumatica (PMR). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 25, 2015. Accessed May 11, 2016.
Questions and answers about polymyalgia Rheumatical and giant cell arteritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Polymyalgia/default.asp. Updated April 2015. Accessed May 11, 2016.
Salvarani C, Cantini F, et al. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347:261.
Soubrier M, Dubost JJ, et al. Polymyalgia rheumatica: diagnosis and treatment. Joint Bone Spine. 2006;73(6):599-605. Review.

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