[Polymyalgia rheumatica in daily routine practice]

Area of Science:

• Rheumatology
• Immunology
• Internal Medicine

Context:

• Polymyalgia rheumatica (PMR) is a painful inflammatory condition predominantly affecting individuals over 50 years old, with a higher incidence in women.
• The disease commonly involves the shoulder girdle and often the pelvic girdle, impacting mobility and quality of life.

Purpose:

• To outline the definition, epidemiology, diagnostic challenges, and current treatment strategies for Polymyalgia Rheumatica (PMR).
• To highlight the importance of accurate diagnosis, differentiating PMR from other musculoskeletal conditions, and the role of updated classification criteria.

Summary:

• PMR affects Caucasians over 50, peaking at 72 years, with women affected twice as often as men.
• Misdiagnosis is common; differential diagnosis includes various shoulder and rheumatic conditions. Elevated ESR and CRP, along with characteristic imaging findings, are crucial for diagnosis.
• New EULAR/ACR classification criteria, incorporating ultrasound, improve diagnostic accuracy.
• Glucocorticoids remain the primary treatment, with careful dose reduction protocols. Methotrexate may be used as an adjunct to reduce steroid dosage and minimize side effects.

Impact:

• Improved diagnostic accuracy through updated criteria and imaging can lead to earlier and more effective treatment initiation.
• Optimized glucocorticoid therapy and the potential use of methotrexate can help manage symptoms and reduce long-term treatment-related complications.
• Enhanced understanding of PMR epidemiology and diagnostic pathways can inform public health strategies and clinical practice guidelines.