Polymyalgia Rheumatica: Symptoms, Diagnosis, and Treatment Options

Polymyalgia rheumatica (PMR) is an inflammatory condition that primarily affects older adults, typically those over the age of 50. It is characterized by aching and stiffness in the shoulder and hip regions, often accompanied by fatigue and mild fever. Though the exact cause remains unknown, PMR is believed to be related to immune system dysfunction, possibly triggered by infections or genetic factors. Early diagnosis and treatment are essential to reduce symptoms and prevent complications.

Recognizing the Symptoms of Polymyalgia Rheumatica

Symptoms of PMR usually develop rapidly over days to weeks and can significantly impact mobility and daily activities. The hallmark symptoms include:


  • Muscle pain and stiffness, especially in the neck, shoulders, upper arms, hips, and thighs

  • Morning stiffness lasting more than 45 minutes

  • Fatigue, malaise, and general feelings of illness

  • Low-grade fever

  • Loss of appetite and unintended weight loss in some cases

Causes and Risk Factors

The exact cause of polymyalgia rheumatica is not fully understood. However, it is considered an autoimmune-related inflammatory condition. The risk factors include:


  • Age above 50 years

  • Female gender, as women are more commonly affected

  • Genetic predisposition and certain human leukocyte antigen (HLA) types

  • Possible triggers such as infections or environmental factors

Diagnosis of Polymyalgia Rheumatica

Diagnosing PMR requires a comprehensive clinical evaluation, as its symptoms can mimic other conditions such as rheumatoid arthritis or fibromyalgia. The diagnostic process typically involves:

1. Medical History and Physical Examination

Physicians assess symptom onset, duration, and pattern of muscle stiffness and pain. Physical examination evaluates range of motion and tenderness.

2. Laboratory Tests

Blood tests play a crucial role in supporting the diagnosis:


  • Erythrocyte Sedimentation Rate (ESR): Usually elevated, indicating inflammation.

  • C-Reactive Protein (CRP): Another marker for inflammation, typically raised in PMR.

  • Complete Blood Count (CBC): To rule out infections or other hematologicalconditions.

3. Imaging

Ultrasound or MRI may be used to detect inflammation in the bursae or joints and to differentiate PMR from other disorders.

Treatment Strategies for Polymyalgia Rheumatica

The cornerstone of PMR treatment is corticosteroid therapy, which dramatically improves symptoms in most patients. Other treatment and management strategies include:

1. Corticosteroids

Low to moderate doses of prednisone or equivalent steroids are usually prescribed. Patients often experience rapid relief of symptoms within days of starting therapy. Treatment duration varies but generally spans months to years with gradual tapering to the lowest effective dose.

2. Monitoring and Managing Side Effects

Long-term steroid use requires monitoring for side effects such as osteoporosis, diabetes, high blood pressure, and infections. Calcium and vitamin D supplementation, along with lifestyle modifications, may be recommended.

3. Alternative and Adjunctive Therapies

In some cases, immunosuppressive drugs such as methotrexate are used to reduce steroid dosage and side effects. Physical therapy can aid in maintaining joint function and muscle strength.

Prognosis and Long-Term Outlook

With timely diagnosis and appropriate treatment, most individuals with polymyalgia rheumatica achieve significant symptom control. However, relapses can occur, requiring adjustments in therapy. Regular follow-up with healthcare providers is important to monitor disease activity and medication side effects.

When to Seek Medical Advice

If you experience persistent muscle stiffness and pain, especially with morning stiffness lasting over 45 minutes, it is important to consult a healthcare professional. Early treatment can prevent complications and improve outcomes.

Conclusion

Polymyalgia rheumatica is a manageable inflammatory condition that primarily affects older adults. Prompt diagnosis and corticosteroid treatment usually provide rapid symptom relief. Long-term management involves monitoring for relapses and side effects. With proper medical care and lifestyle adjustments, individuals with PMR can maintain an active and comfortable life.