Polymyalgia rheumatica (PMR)
Polymyalgia rheumatica (PMR) is an inflammatory disorder primarily affecting older adults, typically those aged 50 and over. It is characterized by pain and stiffness in the shoulders, neck, and hips, particularly worsening in the morning and during movement. While the exact cause of PMR remains unknown, it can be associated with Giant Cell Arteritis (GCA), a serious condition that affects some patients with PMR. Diagnosis involves evaluating symptoms alongside blood tests that measure inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
Treatment commonly involves corticosteroids, which are effective in alleviating symptoms but may lead to side effects, including an increased risk of osteoporosis. As such, long-term monitoring and additional care, such as calcium and vitamin D supplementation, are often recommended. PMR can resolve on its own within months, though some individuals may experience symptoms for years. Regular evaluation for signs of GCA is also important, as this condition can lead to significant complications if left untreated. Understanding PMR is crucial for those affected, as it influences both treatment options and the management of overall health during the course of the disorder.
Polymyalgia rheumatica (PMR)
Disease/Disorder
Anatomy or system affected: Joints, immune system
Definition: An inflammatory disorder of the joints and connective tissues of the shoulders, neck, and hips.
Key terms:
inflammation: the body's natural defense against an insult; characterized by heat, redness, swelling and pain to the area
steroids: an organic compound used as a treatment for treating inflammation
giant cell arteritis: a disease characterized by the inflammation of the arteries and veins that supply the head, neck and arms; it can cause headaches, jaw-pain and changes in vision
joints: a point where two or more bones join together
Causes and Symptoms
Polymyalgia rheumatica (PMR) is an inflammatory disorder of the joints and connective tissues of the shoulders, neck, and hips. The cause is unknown. The stiffness is typically worse in the morning, and PRM affects primarily older adults aged 50 and over. PMR can be associated with Giant Cell Arteritis (GCA); 15–30 percent of patients who have PMR will also have GCA. It is believed that they share some of the same disease processes, although the correlation is poorly understood. GCA is associated with cardiovascular events and should be treated promptly and seriously.
PMR is characterized by pain and stiffness in the shoulders, neck, and hip. The pain is worse in the mornings and with movement and is symmetric. Doing regular activities such as putting a shirt over one's head or rolling over in bed in the morning may be painful or challenging. Pain is usually isolated to the joint and there may be joint swelling or point-tenderness. Muscle pain is usually not a common site of PMR. Overall constitutional symptoms may include fatigue, malaise, depression, and weight loss or gain. High fevers are uncommon, but point more to GCA than PMR.
Diagnosis is through evaluation of one's symptoms and some basic blood tests. The most common tests to check for PMR are called erythrocyte sedimentation rate (ESR) and Creactive protein (CRP) tests. Both of these are markers for inflammation in the body. They are not specific to PMR, but can help paint the overall clinical picture.
Treatment and Therapy
Because PMR is an inflammatory disorder, the medications we use to treat PMR are an anti-inflammatory medicine called steroids. The optimal dose of steroids is tailored to each individual, but the goal is to give symptomatic relief on the lowest effective dose possible. Often, treatment for PMR must last several months. Patients often experience relief within the first few days of treatment.
Steroids are very effective, but also have several side effects that must be monitored closely. Of note is the increased risk of osteoporosis with long-term use. For this reason, clinicians may advise patients to get routine screening for osteoporosis and take supplemental calcium and vitamin D to increase bone strength and decrease the risk of osteoporosis from steroid use. In addition, high blood pressure and diabetes are also associated with long-term steroid use and patients should be screened for these regularly.
Over-the-counter medications for pain such as ibuprofen and acetaminophen are not found to be effective in treating PMR.
Prognosis
PMR usually resolves spontaneously within months, but sometimes can last years. In these cases, side effects from the steroids need to be monitored closely. In addition, signs and symptoms of GCA such as headache, jaw pain, problems with vision, and fever should be evaluated regularly.
Bibliography
Docken, William P. "Polymyalgia Rheumatica." American College of Rheumatology. Amer. College of Rheumatology, 2013. Web. 18 Mar. 2015.
Gota, Carmen E. "Polymyalgia Rheumatica." Merck Manual. Merck, Apr. 2013. Web. 18 Mar. 2015.
Mager, Diana R. "Polymyalgia Rheumatica: Common Disease, Elusive Diagnosis." Home Healthcare Now 33.3 (2015): 132–36. Print.
Rovensky, Jozef, Burkhard F. Leeb, Howard Bird, Viera Stvrtinova, and Richard Imrich, eds. Polymyalgia Rheumatica and Giant Cell Arteritis. New York: Springer, 2010. Print.
Weyand, Cornelia M., and Jörg J. Goronzy. "Giant-Cell Arteritis and Polymyalgia Rheumatica." New England Journal of Medicine 371 (2014): 50–57. Print.