Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disorder that causes widespread aching, stiffness and flu-like symptoms. It is more common in women than men and is seen more often in Caucasians than other races. It typically develops by age 70 and is rarely seen in people younger than 50. PMR may last from one to five years; however, it varies from person to person. Approximately 15 percent of people with PMR develop a potentially dangerous condition called giant cell arteritis.

The cause of PMR is uncertain but it is believed to be an autoimmune disease in which the body’s own immune system attacks healthy tissues. Genetic and environmental factors (such as infections) are thought to play important roles. Because it is rare in people under age 50, its cause could be linked to the aging process.

The symptoms of PMR result from inflammation of the joints and surrounding tissues. Symptoms make start slowly or suddenly. Stiffness is usually worse in the morning and during long periods of inactivity. Sometimes, pain and stiffness can lead to lack of use of some body parts, which could result in muscle weakness. Most people with PMR have pain and stiffness in at least two of the following areas:

• Buttocks.
• Hips.
• Neck.
• Thighs.
• Upper arms and shoulders.

Other symptoms of PMR include:

• Fatigue.
• Fever.
• Poor appetite.
• Weight loss.

PMR may also occur with another serious condition called giant cell artedritis (also known as temporal arteritis), which can be dangerous. New, persistent headaches -- particularly on the side of the head -- scalp tenderness, vision changes or jaw pain when eating can be signs of this condition.

The doctor will ask questions about symptoms and health history and perform a physical examination. Blood tests will be done to check inflammation levels and to rule out conditions that cause symptoms like PMR, such as rheumatoid arthritis and lupus.
Blood tests may include:

• Anticyclic citrullinated peptide (anti-CCP)
• Antinuclear antibody (ANA)
• Complete blood count (CBC)
• C-reactive protein (CRP)
• Erythrocyte sedimentation rate (ESR, also called sed rate)
• Rheumatoid factor (RF)

PMR treatment focuses on reducing pain and inflammation and easing stiffness, achiness, fatigue and fever. Treatment includes anti-inflammatory medication and exercise.

Corticosteroids are powerful anti-inflammatory drugs that help reduce inflammation and relieve stiffness and pain. They are the mainstay of PMR treatment. The dosage for PMR is low and symptoms will improve quickly with treatment. The dosage will be lowered further once symptoms improve.

Occasionally, mild cases of PMR are treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen , to ease symptoms.

Both exercise and rest play important roles in PMR treatment. Regular exercise is essential for maintaining joint flexibility, muscle strength and function. Good forms of exercise include walking, riding a stationary bicycle and exercising in a pool. Rest is also necessary to give the body time to recover from exercise and other activiti

With treatment, PMR symptoms usually lessen or go away within days. Without treatment, they may go away after a year but could take up to five years or more. Proper nutrition , activity, rest and following medication regimens are important for managing the condition. Once stiffness goes away, a person can return to daily activities, including exercise, as tolerated.