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Polymyalgia rheumatica (PMR) is an inflammatory condition which presents muscle pains for the patient, mainly in the shoulders and thighs but also can occur in the buttock area. It is a relatively insidious onset condition, which develops over the course of several weeks during which the pain increases.
As the condition causes pain in the shoulders and thighs, the patient will encounter issues with their mobility, such as turning over in bed or getting in and out of a bath, due to the discomfort. Patients will experience severe stiffness in the morning that lasts longer than 45 minutes. Sometimes the stiffness can be so severe that basic tasks, such as dressing and walking, are difficult to carry out, and the condition can even interfere with a person’s ability to sleep. This can lead to severe tiredness and possibly depression. Patients can also have systemic symptoms, such as a fever or sudden loss of weight.
When diagnosing the condition, the doctor may first wish to conduct a diagnosis of exclusion, as the symptoms of PMR can be similar to other conditions. For patients, for example, who do not respond to treatment, the doctor will consider other causes.
The causes of polymyalgia rheumatica are unknown. It is thought to be an autoimmune condition, which means it develops when the immune system, which defends the body against disease, attacks healthy cells in the body. It is also thought to be related to inflammation in the shoulder girdle, the structures around the shoulders. Some doctors believe the condition represents a type of "vasculitis," or inflammation in the blood vessels, and some imaging techniques have suggested that there is inflammation in the blood vessels in certain types of polymyalgia rheumatica.
The condition is also considered part of a spectrum of illness with polymyalgia rheumatica at the milder end of the spectrum and a condition called "giant cell arteritis" at the more severe end. In giant cell arteritis or temporal arteritis, the patient experiences inflammation of the blood vessels not just in the arms and the legs, but also in the blood vessels carrying blood to the brain and the back of the eye, so it characteristically presents with headache, and unfortunately patients can lose their sight because of the involvement of the blood vessels which supply the eye.
PMR can develop from the age of 50 but is usually found in people over the age of 60. The average age at onset of the disease is 73. Women are about two times more likely to develop the disorder. The condition is also more common among Caucasian people in northern European countries.
The main treatment at present is prednisolone, which is a steroid treatment. There are also other steroid-sparing agent drugs, which are given if it is not possible to reduce the dose of steroids. There is some new research looking into prescribing patients with biologic therapy, including a drug called tocilizumab and an IL-6 receptor antagonist.
At present research is still being conducted to test for their effectiveness, but the clinical trials are looking very promising. Physiotherapy can also be helpful in reducing pain and maintaining mobility.
The benefits of treatment are the same for any rheumatological disease, namely to improve life expectancy and enhance quality of life. As PMR is relatively mild compared to other similar conditions, it is effectively curable when treated, so patients will be able to feel better and return to their pre-PMR state when they have medication. If there is a relapse, treatment is highly effective at stopping the condition from persisting.
