Polymyalgia rheumatica (PMR) is an inflammatory disorder typically affecting older adults, characterized by muscle pain and stiffness around the shoulders, neck, and hips. The exact cause of PMR is unknown, but it is believed to involve inflammation of the blood vessels (vasculitis) and possibly an immune response that has gone awry. Genetics and environmental factors might play roles in its development.
PMR is most common in individuals over 50 years old, with a peak incidence in those in their 70s. It rarely affects people under 50 and is more frequent in women than men. The symptoms of PMR are usually quite distinct: severe muscle aches and stiffness in the morning or after periods of inactivity, fever, malaise, and weight loss. The stiffness is often so severe that it can restrict everyday activities, such as rising from bed, dressing, or raising the arms.
Diagnosis of PMR is primarily based on clinical evaluation, as there are no specific tests that can definitively diagnose the condition. Blood tests often show elevated markers of inflammation, such as the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which support the diagnosis. Physicians may also use ultrasound or magnetic resonance imaging (MRI) to help distinguish PMR from other types of rheumatic diseases.
Treatment typically involves corticosteroids, which are effective in relieving symptoms. The initial dose is usually quite high, with a gradual reduction in the dose over time to minimize side effects. Most patients experience significant improvement in symptoms within a few days of starting treatment. However, the duration of treatment can vary widely; some people may need to continue on low doses of steroids for several years to keep the symptoms under control.
The course of PMR varies. In many cases, it is a self-limiting disease with symptoms lasting from one to two years. However, approximately half of those affected may experience a relapse when their medications are reduced or after discontinuation. It’s crucial for ongoing monitoring and adjustment of therapy to manage these flare-ups effectively.
Additionally, PMR is associated with an increased risk of developing giant cell arteritis (GCA), another inflammatory condition that can cause headaches, visual impairment, jaw pain, and even blindness if not treated promptly. About 10-15% of patients with PMR develop GCA, hence regular monitoring for symptoms of this related condition is essential.
Despite being a chronic condition, PMR can be effectively managed with medications and regular medical care, allowing most individuals to return to their normal activities. Understanding and recognizing the signs and symptoms of PMR, and adhering to prescribed treatment plans are key to managing this condition effectively and minimizing its impact on quality of life.