Polymyalgia Rheumatica (PMR) Diagnosis and Management Summary WHAT? • Polymyalgia rheumatica (PMR) is a common systemic inflammatory disease of unknown cause, resulting in synovitis, bursitis, and tenosynovitis of the neck, shoulder, and hip muscle groups. • Patients over age 50 years, of Scandinavian or Northern European descent, and patients assigned female at birth are more commonly affected than other ethnicities and patients assigned male at birth. • PMR classically presents with an acute onset of bilateral proximal muscle pain and stiffness lasting more than 45 minutes in the morning and resulting in restricted range of motion in the shoulders and hips. • Patients commonly describe difficulty rising from a chair, getting out of bed, or lifting arms to comb or brush hair. • Associated symptoms may include low-grade fevers, anorexia, fatigue, asthenia, and weight loss. CLINICAL: • Physical examination typically reveals painful palpation of bilateral proximal muscle groups with restricted active range of motion and no weakness or muscular atrophy. • An evaluation for giant cell arteritis (GCA) is imperative because PMR occurs in about 50% of patients with GCA. • GCA is associated with significant fevers, weight loss, new headaches, visual changes, and jaw claudication. • Also consider an evaluation for other rheumatic diseases, inflammatory arthropathies, myositis, malignancy, noninflammatory degenerative diseases, hypothyroidism, infection, and fibromyalgia. DIAGNOSIS: • PMR primarily is diagnosed based on clinical presentation, erythrocyte sedimentation rate (ESR) greater than 50 mm/h, and C-reactive protein (CRP) greater than 6 dL/g. • Normocytic anemia, thrombocytosis, and leukocytosis also may occur. • Rheumatoid factor, anti-citrullinated peptide antibodies, creatine kinase, and thyroid-stimulating hormone (TSH) levels generally are normal and can help differentiate PMR from other diseases. • Though not universally used, ultrasound of the shoulders may reveal subacromial-subdeltoid bursitis and long head biceps tendonitis. • Obtain a temporal artery biopsy only when patients have GCA symptoms. TREATMENT: • The mainstay of treatment for PMR is a chronic, slow taper of an oral glucocorticoid, usually for 1 to 2 years until symptoms resolve and inflammatory markers normalize. • Typical starting dose is 15 mg daily for 4 weeks, followed by a taper at 2.5-mg intervals over 2 to 4 weeks to a target dose of 10 mg per day, then slowly tapered at 1-mg intervals every 1 to 2 months for a progressively lower daily dose over 10 to 20 months (until the medication can be discontinued). #Polymyalgia #Rheumatica #PMR #Diagnosis #Management #Rheumatology
