Polymyalgia rheumatica (PMR)

Also known as PMR

Polymyalgia rheumatica (PMR) is a rheumatic disorder that causes moderate to severe pain and stiffness in the neck, shoulder and hip muscles of older adults. This pain and stiffness is often accompanied by a feeling of being unwell and tired. The main treatment for PMR is usually a low-dose corticosteroid medicine plus rest, exercise and physiotherapy.

PMR mostly occurs in people over the age of 50 years and the incidence increases with age. It is more common in women than in men.

The usual course of this disease is anywhere from two to four years. In most cases people recover completely from the symptoms of PMR and lead normal, active lives. Although relapse may occur once treatment is discontinued, symptoms respond rapidly to treatment with corticosteroid.

Causes

The cause of PMR is unknown, and PMR usually lasts between two and four years, although relapse can occur once treatment is stopped.

Researchers are investigating the role of genetic inheritance, immune system abnormalities, and environmental factors as causes.

Symptoms

Pain and stiffness
This may develop very suddenly, even overnight, or over some weeks, mainly in the shoulders, thighs and hips, and possibly spreading to the upper arms, lower back and thighs. These symptoms are often worse in the morning and commonly make getting out of bed difficult. Prolonged inactivity such as sitting for long periods may also increase stiffness. Other symptoms include low-grade fever, weight loss, fatigue and depression.

Temporal arteritis/giant cell arteritis
Some individuals with PMR may also have temporal arteritis, otherwise known as giant cell arteritis, which causes swelling of the arteries in the head. In addition to the symptoms of PMR, these individuals will have the symptoms of temporal arteritis, which are dull headache, jaw pain, and a scalp that is sensitive to the touch in the affected area. Notify your doctor immediately if you experience any of these symptoms, or any changes in your vision.

Diagnosis

Since there is no specific diagnostic test for PMR, diagnosis is made primarily by excluding the presence of other disorders having similar symptoms to this condition. Your doctor will use a combination of your medical history, current symptoms and the results of any evaluations such as blood tests to help with the diagnosis.

Treatment

The treatment of choice for PMR is a low-dose oral corticosteroid such as prednisone. This can lead to a rapid improvement of symptoms within 24 to 48 hours. Your doctor may increase the dose of corticosteroid if the symptoms do not rapidly resolve with the initial dose. Once the symptoms are well controlled, the dose is gradually reduced to the lowest amount of corticosteroid needed to alleviate symptoms.

Treatment is eventually stopped when symptoms are completely eliminated. If symptoms recur at any stage after stopping treatment, then treatment with corticosteroid is restarted. The amount of time that treatment is needed is different for each individual.

Other medications

Non steroidal anti-inflammatory drugs (NSAIDs):A night-time dose of an NSAID such as aspirin or ibuprofen may be useful to relieve mild symptoms of PMR, but does not provide as effective relief of symptoms as corticosteroids.

Disease modifying anti-rheumatic drugs (DMARDs):Azathioprine or methotrexate has sometimes been used to reduce the amount of corticosteroid required in people taking high doses of corticosteroid.

Side effects 

Every medicine can cause side effects. It is important to discuss with your doctor or pharmacist what these are, the likelihood of these happening and the possible results.

Rest, exercise and physiotherapy

Rest is important in the active phase and appropriate amounts of exercise may be increased once the stiffness starts to resolve. Physiotherapy is useful to help reduce pain and to avoid muscle wasting in severe cases.

Learn more

Arthritis New Zealand employs skilled educators who can give information and advice, and put you in touch with support and exercise groups throughout the country. Self-management courses are also available and are designed to give people the skills to take a more active part in their care, together with a healthcare team.
Polymyalgia rheumatica (PMR) Southern Cross Healthcare Group, 2012

Credits: Original material supplied by Arthritis New Zealand, 2009. Reviewed By: Health Navigator