Polymyalgia rheumatica (PMR) is an inflammatory condition that can cause aching and stiffness. It tends to affect the neck, shoulders, and hips. The aching and stiffness are usually worse in the morning or after long periods of inactivity.
Causes and Risk Factors
The cause of PMR is unknown. PMR does not arise from side-effects of medications. PMR should not be confused with a condition called fibromyalgia, a poorly understood condition that affects mainly younger adults and does not involve arthritis.
Some factors seem to increase the risk of polymyalgia rheumatica. These include:
Age (occurrence only in adults aged 50+)
Race (more frequently seen in Caucasians, though all races can be affected)
Sex (more frequently seen in women than men)
The main symptoms of polymyalgia rheumatica (PMR) are aching and stiffness about the upper arms, neck, and thighs. Symptoms tend to develop quickly, over days or weeks, occasionally even over night. Initially one part of the body can be affected more than the other but, over time, symptoms involve the upper arms and upper legs on both sides. Aching and stiffness are always worse in the morning and will tend to gradually improve as the day goes by. However, if there are prolonged periods of inactivity, stiffness will return.
Stiffness can be so severe that there are night pains, problems getting dressed in the morning, (such as putting on a jacket or bending over to pull on socks and shoes), or difficulty getting up from a low chair. A classic symptom of PMR is difficulty raising the arms above the shoulders.
Diagnosing PMR can be challenging as many conditions cause similar symptoms, including rheumatoid arthritis and fibromyalgia. However, two blood tests are commonly used to make a diagnosis of PMR. These include:
Erythrocyte sedimentation rate
If the diagnosis of PMR is strongly suspected, a trial of low dose steroids (glucocorticoids) is given, usually in the form of 10-15 mg of prednisone per day. If PMR is present, the response to steroids can be dramatic – sometimes patients experience improvement after only one dose – but sometimes the response is slower. If symptoms have not been completely relieved after 2 to 3 weeks of low dose steroids, the diagnosis of PMR must be questioned, and other diagnoses should be considered.
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