Polymyalgia rheumatica (PMR) is a relatively common chronic inflammatory condition affecting older adults that is characterized by proximal myalgia and morning stiffness of the neck, shoulders, and hip girdle. Among rheumatic conditions in adults, the lifetime risk of this disease is second only to rheumatoid arthritis. PMR is significant for its association with giant cell arteritis (GCA), which approximately 10% of PMR patients will develop. Similarly, up to 50% of patients diagnosed with GCA have manifestations of PMR. Although the etiology of both is unclear, many believe that the 2 entities share a common pathophysiology. People of European descent are at greatest risk, while those of Asian, Latino, and African American heritage are the least susceptible.
The onset of symptoms can be abrupt. They are most noticeable upon arising from bed in the morning; in fact, the absence of morning stiffness helps to exclude the diagnosis. Associated synovitis can limit range of motion in affected joints: the classic finding in a patient with PMR is the inability to raise the arms above 90°. ESR and CRP are often elevated. Patients with PMR should be asked about symptoms typical of GCA. Temporal artery biopsy is not indicated in patients without signs and symptoms of GCA, as it rarely yields positive results.
Prednisone typically brings dramatic relief in 2–3 days, with complete recovery often occurring within 3 weeks. Patients without relapses can usually be tapered off by 1 year. If patients need longer-term treatment, methotrexate may be helpful in reducing the steroid requirement. Other biologics have not shown consistent results.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.