What is polymyalgia rheumatica (PMR)?
Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown cause. It is recognised to be an autoimmune illness. It causes pain, tenderness and stiffness in the large muscles around the shoulders, hips and back. It mainly affects people over the age of 50 with the peak being in the 7th and 8th decades of life. It tends to affect women more than men.
While some people recover after a year or two of treatment with corticosteroids (steroids) some individuals may have disease resistant to treatment and need long-term steroids.
Have you just been diagnosed with PMR?
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What are the symptoms?
Symptoms often appear very suddenly, over just a few days, or may develop more slowly. The pain is always developed around the shoulders and always equal on both sides. In addition, some individuals may develop neck and back pain and symmetrical hip pain. Typically, people find it difficult to get out of bed in the morning. Tasks that need raising the arms above shoulder level become difficult to perform (like washing hair or getting things out of overhead cupboards and shelves). In addition, people may suffer with:
- Low mood
- Night sweats
- Loss of appetite
- Weight loss
It is important to note that these symptoms are not unique to polymyalgia rheumatica. Your doctor may need to run tests to exclude conditions like rheumatoid arthritis, myositis and giant cell arteritis (GCA) prior to starting you on steroid treatment.
How is it diagnosed?
There is no unique symptom of polymyalgia rheumatica and no unique blood test that confirms the diagnosis. Doctors have to think about other possible causes of the symptoms and, especially if you have lost weight, will want to rule out other serious illnesses. Your doctor will request blood testing to look for levels of inflammation. The key tests are ‘ESR’ or Erythrocyte Sedimentation Rate and ‘CRP’ or C-Reactive Protein. Rarely is it possible for PMR to be diagnosed with normal blood tests. But this should always be diagnosed by a specialist rather than in primary care.
What is the treatment?
Once diagnosed, treatment is with steroid tablets (usually prednisolone) and symptoms can improve spectacularly. The usual recommended starting dose is 15mg daily, which is then tapered down slowly with a view to stopping in completely. It will take some people about 2 years to come off steroids, but we know that for others it will be longer. Research shows that 25% of people with PMR will still be on steroids after 4 years.
It is not unusual for some pains to return as the dose of prednisolone comes down. That is usually because of unmasking of pain, because of natural wear and tear of joints (commonly called osteoarthritis). This does not need to be treated with steroids. In some people the natural steroid production may stop, and will cause symptoms very similar to polymyalgia rheumatica. Therefore, when PMR relapse is suspected, your doctor may run tests to ensure that your natural steroid production (cortisol) is normal. However, in a small number of individuals, PMR may genuinely need a continuing low dose of prednisolone to keep the inflammation and symptoms at bay.
Are there any complications?
PMR is a debilitating condition and most of the complications that individuals face is related to the need for steroids. Weight gain, brittle bones, diabetes and high blood pressure are all things to watch out for. Some people with PMR may also develop giant cell arteritis (GCA) which is a condition causing inflammation of blood vessels. What was thought to be PMR has also been known to turn out to be rheumatoid arthritis.