Polymyalgia Rheumatica

Relatively common chronic inflammatory condition of unknown aetiology that affects elderly individuals

Aetiology

  • Occurs almost exclusively in patients > 50 years
  • Incidence higher in northern regions
  • Associated with giant cell arteritis
    • Approximately 15% of patients with PMR develop giant cell arteritis (GCA), and 40-50% of patients with GCA have associated PMR

Clinical presentation

Symptoms

  • Proximal myalgia of the hip and shoulder girdles with accompanying morning stiffness that lasts for at least 45 mins
    • Usually symmetrical
    • Usually occurs relatively quickly - stiffness develops over a few weeks
    • Pain is worse with movement
  • Systemic symptoms such as fatigue, anorexia, weight loss and fever may occur

Signs

  • Reduced movement of shoulders, neck and hips
  • Muscle strength is normal
  • Upper arm tenderness
  • Carpel tunnel syndrome
  • Pitting oedema

Investigations

  • Mainly clinical diagnosis
  • Bloods - raised inflammatory markers

Management

  • Rapid and dramatic response to low dose steriods
  • Start at prednisolone 15mg daily
  • Gradual reduction in steriod dose over 18 months to 2 years
    • By the end of this period the condition will have resolved in the majority of cases