What are the other Names for this Condition? (Also known as/Synonyms)

• Anarthritic Syndrome
• Arthritic Rheumatoid Disease
• PMR (Polymyalgia Rheumatica)

What is Polymyalgia Rheumatica? (Definition/Background Information)

• Polymyalgia Rheumatica (PMR) is a rare disorder that involves the muscles and joints in the body. It can result in pain and discomfort involving the joints, stiffness of the muscles, and flu-like symptoms, in some cases
• The cause of Polymyalgia Rheumatica is generally unknown. However, various factors, such as genetics, immunological factors, and certain environmental triggers, may be involved
• In many individuals, Polymyalgia Rheumatica is seen in association with another systemic condition called giant cell arteritis, which is an autoimmune inflammatory disorder of the blood vessels
• Polymyalgia Rheumatica usually affects older individuals. There is an increased risk for adults over the age of 50 years, especially for women. The symptoms are known to come and go over time. The condition may impair the quality of life in some individuals
• The treatment of Polymyalgia Rheumatica involves the use of pain medication, non-steroidal anti-inflammatory drugs, and physical therapy. In many, a spontaneous resolution may be noted after a year; while, in others, it may last even over five years. However, Polymyalgia Rheumatica is known to respond well to treatment

Who gets Polymyalgia Rheumatica? (Age and Sex Distribution)

• Polymyalgia Rheumatica is generally seen in middle-aged and older adults above the age of 50 years. In individuals over 50 years of age, the incidence rate of PMR is about 1 in 2,000
• A peak incidence is noted in between the years 70 and 80 (i.e., among elderly adults)
• In general, more females are affected than males
• No racial and ethnic group predisposition is reported and all groups are at risk for PMR. However, more number of cases has been recorded among the Caucasians of north Europe and USA

What are the Risk Factors for Polymyalgia Rheumatica? (Predisposing Factors)

The specific risk factors associated with Polymyalgia Rheumatica (PMR) are not well-established; however, the following are noted:

• Middle-aged and older women have an increased risk of developing this disorder
• A family history of the condition may be a risk factor
• In a majority of cases, giant cell arteritis, which is a systemic autoimmune inflammatory condition that results in inflammation of the blood vessels, is present along-with PMR

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Polymyalgia Rheumatica? (Etiology)

The exact mechanism of development of Polymyalgia Rheumatica is not well-understood.

• It is believed to develop from a combination of factors that include an abnormal immune response, aging process, genetics, and certain environmental factors, such as an infection
• In a minority of cases, a positive family history has been reported. Researchers believe that the gene involved in the condition may be the HLA-DR4 gene, although it is not proven conclusively yet

What are the Signs and Symptoms of Polymyalgia Rheumatica?

The signs and symptoms of Polymyalgia Rheumatica may vary from one individual to another; it may be mild or severe. The onset of symptoms may be sudden; or, it may develop gradually over time (over weeks and months), which is seen in many cases.

The signs and symptoms include:

• Pain and discomfort in the shoulder, neck, or hip, which affects one side of the body first, to then slowly involve both sides of the body
• Other parts of the body may be then involved, including the upper arms, lower back, and thighs
• Muscle pain is noted in most cases, along-with stiffness of the joints
• The pain and stiffness may be severe when the body remains inactive for a long time, such as after a night’s sleep
• The lower extremities (hands and feet) and arms and legs are usually not affected
• 1 in 3 individuals may develop symptoms similar to rheumatoid arthritis such as joint pain, tenderness, and swollen joints
• Flu-like symptoms may be seen in some, including low-grade fever, fatigue, body pain, and weight loss
• The symptoms of giant cell arteritis, if present, may be noted. These include generalized headache, facial pain, swollen blood vessels, and loss of appetite

There may be periods of remission and exacerbation - the symptoms may disappear and reappear over time. This ‘coming and going’ of symptoms may go on for many months to years (from 1-6 years).

How is Polymyalgia Rheumatica Diagnosed?

There are a variety of diagnostic tests and exams that a healthcare provider may use to help diagnose Polymyalgia Rheumatica and these include:

• Complete physical examination and evaluation of one’s medical history
• Assessment of the presenting signs and symptoms
• Complete blood count
• Erythrocyte sedimentation rate (ESR) blood test
• Joint fluid analysis may be undertaken
• X-rays of the affected joint
• Ultrasound imaging of joints, if needed
• Tests to diagnose underlying giant cell arteritis, if any

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Polymyalgia Rheumatica?

The complications of Polymyalgia Rheumatica are generally rare, but may include:

• Severe joint pain causing movement difficulties
• Atrophy of muscles
• Decreased quality of life
• Complications due to underlying giant cell arteritis that includes blindness, formation of aneurysm, and even stroke

How is Polymyalgia Rheumatica Treated?

The treatment measures for Polymyalgia Rheumatica may include:

• Use of pain medication
• Administration of corticosteroids (low or moderate dose)
• Use of non-steroidal anti-inflammatory oral medications (NSAIDs), when giant cell arteritis is not present
• Symptomatic and supportive therapy
• Physical therapy exercises that aid in strengthening and improving flexibility of the joints, and to also help reduce discomfort
• Undertaking treatment of underlying giant cell arteritis, if present

How can Polymyalgia Rheumatica be Prevented?

• Currently, there are no preventable measures associated with Polymyalgia Rheumatica
• Regular medical screening at periodic intervals with tests and physical examinations are recommended

What is the Prognosis of Polymyalgia Rheumatica? (Outcomes/Resolutions)

• The prognosis of Polymyalgia Rheumatica is generally good with appropriate treatment, since the condition responds well to treatment. The overall prognosis is also dependent on the presence of giant cell arteritis, if any present
• The condition can be self-limiting and disappear within 12 months. But, Polymyalgia Rheumatica may also last long and affect the overall quality of life in some individuals. Occasionally, it can cause severe disability and degeneration of the muscles and joints

Additional and Relevant Useful Information for Polymyalgia Rheumatica:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/