Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a chronic inflammatory disorder that primarily affects people over the age of 50. It is characterized by pain and stiffness in the neck, shoulders, pelvic girdle, and thighs. Although the exact cause of PMR is not known, it is believed to be related to immune system and genetic factors.


Diagnosis:

The diagnosis of PMR is based on the clinical presentation and laboratory findings. Symptoms include pain and stiffness in the neck, shoulders, pelvic girdle, and thighs, which are worse after prolonged sitting or lying down and improve after moving. Patients may also have a low-grade fever, fatigue, weight loss, and decreased appetite.

Blood work may show an increase in erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which are signs of inflammation. However, these findings are not specific to PMR and may be present in other inflammatory diseases.


Phenotypes:

PMR can be divided into two main phenotypes: typical PMR and atypical PMR. Typical PMR is characterized by the acute onset of pain and stiffness in the neck, shoulders, pelvic girdle, and thighs, with a rapid and complete response to steroids. Atypical PMR is less common and is associated with a more insidious presentation, less severe pain, and reduced response to steroids.


Treatment:

Treatment of PMR involves the use of corticosteroids to reduce inflammation and pain. Steroids are prescribed in a low dose to relieve symptoms and then gradually reduced as symptoms improve. Low doses of steroids may be required for several years.

Physical therapy and stretching exercises can also be helpful in improving flexibility and mobility.

It is important that PMR patients continue to be closely monitored by a doctor for possible complications, such as osteoporosis and fractures. They should also be evaluated for the presence of coronary artery disease and other inflammation-related diseases.