Polymyalgia Rheumatica (PMR): Symptoms, Tests and Treatments

In previous articles, we have offered insight into the diagnosis, treatment and management of various systemic rheumatic diseases such as rheumatoid arthritis, scleroderma, vasculitis, and lupus.

In the following article, we focus on another condition that rheumatologists often treat: Polymyalgia Rheumatica (PMR).

Below, we will define PMR, highlight its common symptoms, discuss the various tests used to determine if a patient has PMR, and explain the ways rheumatologists treat this inflammatory condition.  

What is Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is a condition that causes pain, stiffness and inflammation. PMR is more commonly seen in adults over age 60. Women are more likely to develop PMR.

Polymyalgia Rheumatica Symptoms

Symptoms of PMR include the following:

o   Aches and pain in the shoulders, upper arms, neck, lower back, hips, buttocks and thighs (often referred to as “shoulder girdle” or “pelvic girdle” areas)

o   Stiffness in the affected areas which may cause difficulty dressing, bending over and/or getting in and out of a bed/car/chair

o   Limited range of motion especially in the upper arms, which may be because of pain

o   Difficulty sleeping

o   Loss of appetite and/or weight loss

o   Fatigue, malaise and/or depression

o   Fever

PMR often develops quickly. Patients may begin to experience symptoms over the course of a few days or weeks. In other instances, symptoms develop overnight. Early mornings are typically the most challenging time of day as the immune system strengthens overnight and given inactivity while sleeping.

A portion of patients with PMR (~ 10%) may also experience additional symptoms caused by Giant Cell Arteritis (GCA), another inflammatory condition which affects the larger blood vessels (aorta) and its branches in the body. Symptoms of GCA may include: headaches in the temple region, vision issues, jaw pain, scalp tenderness, weight loss/fatigue, chest pain, elevated platelet count.

Patients may experience both conditions simultaneously.

The exact causes of PMR are unknown, although a genetic cause or even a viral trigger may be possibilities. Recent studies suggest that the pain and stiffness felt in PMR may be caused by not only joint but also bursa (fluid filled sacs outside the joint) inflammation (“bursitis”). Inflammation in these areas can cause referred pain into the arms and thighs. 

Polymyalgia Rheumatica Tests

There are no specific tests to diagnose PMR. PMR is a diagnosis of exclusion, meaning that it is important to think of other conditions that may mimic the clinical presentation. In PMR, inflammation markers, erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) are often elevated. However, because these lab tests are not specific to one disorder, elevations have to be taken in the correct context of the patient’s symptoms.

Polymyalgia Rheumatica Treatments

Rheumatologist may prescribe corticosteroids such as prednisone if they suspect PMR. Often, only a low-moderate dose is required to effectively treat the symptoms. If the patient begins to experience relief from stiffness, aches and pains within days, then PMR is likely the cause of the symptoms.

Once the symptoms begin to diminish, the steroids are tapered slowly over the course of a year-18 months. Given the long term use of steroids, attention to bone health is essential as well. Future studies are needed to identify other medications that may be used as “steroid sparing” agents in the treatment of PMR.