Polymyalgia rheumatica

Polymyalgia rheumatica, or PMR, is a common cause of aching and stiffness in older adults over the age of 50 which has evidence of inflammation on blood testing. The aching and stiffness is in the neck, upper arms, buttocks and thighs, and is worst in the mornings. It usually starts rapidly and affects both sides of the body equally. It is often uncomfortable to raise the arms above the shoulders. The stiffness can interfere with sleep and make it difficult to get dressed or get in and out of a car in the mornings.

The cause is unknown and there is no evidence of damage to the muscles or the shoulder and hip joints where the pain starts and is then referred to the upper arms and legs where it is felt. PMR is in older patients with a high ESR and CRP and responds very well to corticosteroids, while fibromyalgia is in younger patients with normal labs and little response to corticosteroids. NSAIDs are not effective.

Usually 10 – 15 mg a day of Prednisone can quickly relieve the pain and stiffness in PMR and allow normal activities. No response after 2-3 weeks makes PMR unlikely. Patients with PMR are usually tapered slowly to a much lower dose that they may need to take for 1-3 years. Even low dose cortisone can cause higher blood sugar, weight gain, anxiety, sleeplessness, osteoporosis, cataracts, muscle weakness, bruising and thinning of the skin. DEXA scan testing for osteoporosis and checking for complications during treatment with corticosteroids is important. PMR can occur with a much more serious condition, giant cell arteritis, about 10% of the time.

See your rheumatologist right away if you have PMR and develop headache, rapid changes in vision and/or unexplained fever. The Vasculitis Foundation is available for more information.