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Polymyalgia rheumatica.

Carlo Salvarani1, Fabrizio Cantini, Luigi Boiardi

  • 1Rheumatology Service, Arcispedale S. Maria Nuova, V. le Risorgimento N80, 42100 Reggio Emilia, Italy. salvarani.carlo@asmn.re.it

Best Practice & Research. Clinical Rheumatology
|September 30, 2004
PubMed
Summary
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Polymyalgia rheumatica (PMR) causes aching and stiffness in the shoulders and hips. While corticosteroids are the primary treatment, further research is needed to explore corticosteroid-sparing options for managing this inflammatory condition.

Area of Science:

  • Rheumatology
  • Immunology

Background:

  • Polymyalgia rheumatica (PMR) is an inflammatory condition causing pain and stiffness in the shoulders, hips, and neck.
  • Historically, PMR was linked to giant cell arteritis (GCA) or elderly-onset rheumatoid arthritis (EORA).
  • Current diagnostic criteria are empirically based on expert consensus.

Purpose of the Study:

  • To review the understanding of PMR, including its pathophysiology, diagnosis, and management.
  • To highlight the role of synovitis in PMR symptoms.
  • To discuss the limitations of current diagnostic markers and treatment strategies.

Main Methods:

  • Literature review and synthesis of existing research on Polymyalgia Rheumatica.
  • Analysis of diagnostic criteria and imaging studies (arthroscopy, radioisotopic, MRI).

Related Experiment Videos

  • Evaluation of laboratory markers (ESR, CRP, IL-6) and treatment outcomes.

    • Main Results:

    • Imaging studies confirm synovitis in proximal joints and periarticular structures, likely causing PMR symptoms.
    • Distal musculoskeletal manifestations occur in about half of PMR patients.
    • Normal erythrocyte sedimentation rate (ESR) does not rule out PMR; C-reactive protein (CRP) and interleukin-6 (IL-6) are more sensitive indicators of disease activity.

    Conclusions:

    • Corticosteroids are the mainstay treatment for PMR, often requiring 1-2 years of therapy, with some patients needing long-term low-dose treatment.
    • Further large-scale studies are essential to establish the efficacy of methotrexate and anti-TNF-alpha agents as corticosteroid-sparing therapies in PMR management.