Polymyalgia rheumatica - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Polymyalgia rheumatica (PMR) is an inflammatory rheumatologic syndrome. Affected patients describe difficulty rising from seated or prone positions, significant shoulder and hip girdle stiffness, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis.
More common in women.
About 15% to 20% of patients with PMR have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.
Diagnosis is made via history and with supportive laboratory tests indicating an elevated ESR or CRP.
Rapid improvement often occurs within 24 to 72 hours with low-dose prednisone.

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Definition

Epidemiology

Etiology

Pathophysiology

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Scoring algorithm for the classification of PMR

Citations

Key Articles

Nothnagl T, Leeb BF. Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica. Drugs Aging. 2006;23:391-402.[Abstract]
Buttgereit F, Dejaco C, Matteson EL, et al. Polymyalgia rheumatica and giant cell arteritis: A systematic review. JAMA. 2016 Jun 14;315(22):2442-58.[Abstract]
Dejaco C, Singh YP, Perel P, et al; European League Against Rheumatism; American College of Rheumatology. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67:2569-2580.[Abstract][Full Text]

Referenced Articles

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4. Nothnagl T, Leeb BF. Diagnosis, differential diagnosis and treatment of polymyalgia rheumatica. Drugs Aging. 2006;23:391-402.[Abstract]
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26. Salvarani C, Boiardi L, Mantovani V, et al. HLA-DRB1, DQA1, and DQB1 alleles associated with giant cell arteritis in northern Italy. J Rheumatol. 1999;26:2395-2399.[Abstract]
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28. Helfgott SM, Kieval RI. Polymyalgia rheumatica in patients with a normal erythrocyte sedimentation rate. Arthritis Rheum. 1996;39:304-307.[Abstract]
29. Salvarani C, Cantini F, Niccoli L, et al. Acute-phase reactants and the risk of relapse/recurrence in polymyalgia rheumatica: a prospective followup study. Arthritis Rheum. 2005;53:33-38.[Abstract]
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31. Cantini F, Salvarani C, Olivieri I, et al. Erythrocyte sedimentation rate and C-reactive protein in the evaluation of disease activity and severity in polymyalgia rheumatica: a prospective follow-up study. Semin Arthritis Rheum. 2000;30:17-24.[Abstract]
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35. Pease CT, Haugeberg G, Morgan AW, et al. Diagnosing late onset rheumatoid arthritis, polymyalgia rheumatica, and temporal arteritis in patients presenting with polymyalgic symptoms: a prospective longterm evaluation. J Rheumatol. 2005;32:1043-1046.[Abstract]
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43. Healey LA. Long-term follow-up of polymyalgia rheumatica: evidence for synovitis. Semin Arthritis Rheum. 1984;13:322-328.[Abstract]
44. Dasgupta B, Cimmino MA, Kremers HM, et al. 2012 Provisional classification criteria for polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheum. 2012;64:943-954.[Abstract][Full Text]
45. Dejaco C, Singh YP, Perel P, et al; European League Against Rheumatism; American College of Rheumatology. 2015 recommendations for the management of polymyalgia rheumatica: a European League Against Rheumatism/American College of Rheumatology collaborative initiative. Arthritis Rheumatol. 2015;67:2569-2580.[Abstract][Full Text]
46. Li C, Dasgupta B. Corticosteroids in polymyalgia rheumatica: a review of different treatment schedules. Clin Exp Rheumatol. 2000;18:S56-S57.[Abstract]
47. American College of Rheumatology. 2022 Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Oct 2023 [internet publication].[Full Text]
48. Dejaco C, Singh YP, Perel P, et al. Current evidence for therapeutic interventions and prognostic factors in polymyalgia rheumatica: a systematic literature review informing the 2015 European League Against Rheumatism/American College of Rheumatology recommendations for the management of polymyalgia rheumatica. Ann Rheum Dis. 2015;74:1808-1817.[Abstract][Full Text]
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50. Dejaco C, Duftner C, Cimmino MA, Dasgupta B, Salvarani C, Crowson CS, Maradit-Kremers H, Hutchings A, Matteson EL, Schirmer M; International Work Group for PMR and GCA. Definition of remission and relapse in polymyalgia rheumatica: data from a literature search compared with a Delphi-based expert consensus. Ann Rheum Dis. 2011;70:447-453.[Abstract][Full Text]
51. Lally L, Forbess L, Hatzis C, et al. Brief report: a prospective open-label phase IIa trial of tocilizumab in the treatment of polymyalgia rheumatica. Arthritis Rheumatol. 2016 Oct;68(10):2550-4. [Abstract][Full Text]
52. Devauchelle-Pensec V, Berthelot JM, Cornec D, et al. Efficacy of first-line tocilizumab therapy in early polymyalgia rheumatica: a prospective longitudinal study. Ann Rheum Dis. 2016 Aug;75(8):1506-10. [Abstract][Full Text]
53. Mori S, Koga Y. Glucocorticoid-resistant polymyalgia rheumatica: pretreatment characteristics and tocilizumab therapy. Clin Rheumatol. 2016;35:1367-1375.[Abstract][Full Text]
54. Al Rashidi A, Hegazi MO, Mohammad SA, et al. Effective control of polymyalgia rheumatica with tocilizumab. J Clin Rheumatol. 2013;19:400-401.[Abstract]
55. Akiyama M, Kaneko Y, Takeuchi T. Tocilizumab in isolated polymyalgia rheumatica: A systematic literature review. Semin Arthritis Rheum. 2020 Jun;50(3):521-5.[Abstract]
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60. Salvarani C, Cantini F, Boiardi L, et al. Polymyalgia rheumatica and giant-cell arteritis. N Engl J Med. 2002;347:261-271.[Abstract]
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