There are many who wake up from Polymyalgia rheumatica (PMR) pain early in the mornings.
Patients seem to develop this disorder rapidly overnight. This is not to rule
out patients who develop pain due to PMR in
the evenings as well.
Taken from Greek, 'polymyalgia rheumatica' means 'pain in the muscles'. PMR is a
rheumatic disorder, an inflammatory condition of the muscles causing pain and
stiffness in the neck, shoulders and hips. Some patients are likely to develop
swelling or edema of the hands, wrists, ankles and top of the feet.
The mobility of the shoulders, neck and hips is reduced after PMR. Muscle weakness
gradually becomes a problem because of lack of use due to pain and stiffness. PMR
is not a life threatening illness but it does require treatment and therapy for
two to four years. The pain from Polymyalgia rheumatica (PMR) can either be
very sudden and excruciating or can gradually occur over a period of time.
It is estimated that in the US, 700 per 100,000 people in the general population aged 50 years or older develop
Although what triggers of PMR is unknown, it is understood that the white blood cells in
the body attach to the lining in the joints and cause this inflammation. Genetic
and environmental factors cause PMR. Aging also plays an important role.
It has been found that PMR can be inherited especially in genetically susceptible
individuals whose immune system can be stimulated by virus. Some prominent
virus linked with PMR is adenovirus which causes respiratory infections, human
parvovirus B 19 which usually affects children and human parainfluenza virus.
Although the etiology of PMR is unknown, those aged 50 and above run the risk of PMR.
Another risk factor of this chronic, episodic and inflammatory disease is
presence of giant cell arteritis.
Who is at risk of PMR?
Women are twice as likely to develop PMR as men. White women over the age 50 with giant
cell arteritis are most at risk of developing PMR. Average age at onset is 70
Signs and symptoms of polymyalgia rheumatica
There are a wide range of symptoms that indicate PMR. The most common include:
- Moderate to severe pain which can be abrupt or rapid onset in the shoulder and pelvic
Swelling of the knees, wrists and mid and upper chest joints.
Fatigue and malaise
- Lack of appetite
- Unintentional weight loss
- Illness and slight fever
- Difficulty in combing hair, putting on coat or even getting out of a chair
show that about 50% of people with temporal arteritis suffer Polymyalgia
rheumatica. Common symptoms of temporal arteritis are:
Jaw and facial soreness
Ache in the limbs caused by decreased blood flow
Diagnosis of PMR
There are a limited number of diagnostic tests that can be done to diagnose Polymyalgia
rheumatica. A doctor can physically note the swelling of the joints in the
wrists and hands and limited motion in the shoulders.
ESR blood test is done to measure how fast the red blood cells of the patients can settle
in the tube. The faster the blood cells settle, the higher the value of ESR and
more the inflammation. As many conditions can cause elevated ESR, this test
cannot be construed as a proof of PMR.
C-reactive protein is another diagnostic test which usually shows high levels in patients
with PMR. As CRP is produced by the liver in response to an injury or
infection, this test again is non-specific. Serologic tests such as rheumatoid
factor and antinuclear antibody tests as well as muscle related enzyme assays
such as creatinine photokinase are done.
Rheumatoid factor is an antibody sometimes found in the blood. Although patients with
rheumatoid arthritis are most likely to have rheumatoid factor in their blood,
patients with PMR do not.
Routine x rays of the joints rarely help reveal any abnormalities. Magnetic resonance
imaging (MRI) can confirm the presence of inflammation. Ultrasounds and PET
scanning (Positron emission tomography) also help to confirm PMR inflammation. Usually
the diagnosis of PMR is based on three observations:
Clinical syndrome and doctor's physical observation
Elevated level of ESR and response to low dose steroid
Rapid and dramatic response to corticosteroid therapy
As PMR is
associated with temporal arteritis, a biopsy sample of the temporal artery is
taken to confirm this condition.
Polymyalgia rheumatica and Giant cell arteritis
It is estimated that about 15% of people in the US with polymyalgia rheumatic also
develop giant cell arteritis. The patients with PMR either develop giant cell
arteritis simultaneously or after PMR symptoms disappear.
It is essential that the doctor looks for symptoms of giant cell arteritis in
patients diagnosed with PMR. This is mainly because of the risk of blindness as
untreated giant cell arteritis can lead to permanent vision loss and stroke.
However, with proper treatment, the disease is not threatening.
Treatment of PMR
The symptoms of PMR can be quickly controlled with treatment although relapse can
occur if treatment is stopped too early. Therapy for PMR may require several
months or years. Average duration of illness is about two to four years. Since
the goal of treating PMR is to relieve pain and stiffness, medications coupled
with proper exercise and rest becomes essential.
Anti inflammatory medicines such as aspirin and ibuprofen are commonly prescribed to
treat mild cases of PMR. For more serious cases, corticosteroid drugs are used
to reduce inflammation. But corticosteroids should be used briefly for six
months or for a maximum of one to two years, although some patients need to be
treated longer. Corticosteroid tends to cause side effects such as weight gain,
osteoporosis and increased risk of infection, cataracts, glaucoma and high
Non steroid anti inflammatory drugs are also used to treat PMR. These can help
relieve pain and stiffness and they are not as strong as corticosteroids. Mild
cases of PMR can be treated with non steroid drugs alone. But these drugs tend
to cause ulcers and bleeding in the stomach and should be taken with food.
Along with medical therapy, the patients should exercise and eat healthy. Exercise
can strengthen the weak muscles and prevent weight gain. A healthy diet is
imperative to maintain a strong immune system and build strong muscles and
Many with PMR lead productive and active lives. The duration of the medicines prescribed and that
of drug treatment differs from one patient to another. With proper treatment,
PMR rarely recurs.