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[Polymyalgia rheumatica]
1Department of Internal Medicine, National Tokyo Medical Center.
Abstract:
Polymyalgia rheumatica (PMR) is a disease of unknown etiology characterized by severe myalgia and stiffness at shoulder girdle and pelvic girdle muscles and by normal serum creatine kinase levels. Marked elevation of erythrocyte sedimentation rate, acute onset within two weeks, and appearance in the aged are also additional characteristics of PMR. Ten to 50% of PMR patients have a concomitant temporal arteritis (TA)(giant cell arteritis). For the differential diagnoses of PMR, rheumatoid arthritis, polymyositis, fibromyalgia, malignancies, infections and depression should be considered. PMR without TA is treatable successfully with small amount of steroids (15-20 mg/day of prednisolone). For the PMR patients with TA should be treated with large amount of steroids (40-60 mg/day of prednisolone) or steroid pulse therapy.
Insights
Polymyalgia rheumatica (PMR) causes severe muscle pain and stiffness, particularly in the shoulders and hips. Early steroid treatment is effective, with higher doses needed if temporal arteritis is also present.
Area of Science:
- Rheumatology
- Immunology
- Internal Medicine
Context:
- Polymyalgia rheumatica (PMR) is an inflammatory condition affecting older adults.
- Characterized by proximal muscle stiffness and pain, normal creatine kinase, and elevated erythrocyte sedimentation rate.
- A significant subset of PMR patients (10-50%) also present with concomitant temporal arteritis (TA), also known as giant cell arteritis.
Purpose:
- To outline the key diagnostic features of Polymyalgia Rheumatica.
- To discuss differential diagnoses including rheumatoid arthritis, polymyositis, fibromyalgia, malignancies, infections, and depression.
- To differentiate treatment strategies based on the presence or absence of concomitant temporal arteritis.
Summary:
- PMR presents with severe shoulder and pelvic girdle myalgia and stiffness, typically with acute onset in the elderly and elevated ESR.
- Normal serum creatine kinase levels are a hallmark, distinguishing it from other myopathies.
- Treatment involves corticosteroids: low-dose (15-20 mg/day prednisolone) for PMR alone, and high-dose (40-60 mg/day prednisolone) or pulse therapy for PMR with TA.
Impact:
- Accurate diagnosis and tailored steroid therapy are crucial for effective management of PMR and its potential complication, TA.
- Understanding the distinction in treatment intensity based on TA presence optimizes patient outcomes and minimizes steroid-related side effects.
- This approach aids clinicians in managing PMR, a common cause of inflammatory symptoms in the elderly.