Polymyalgia rheumatica (PMR) is an inflammatory rheumatologic syndrome. Affected patients describe difficulty rising from seated or prone positions, significant shoulder and hip girdle stiffness, varying degrees of muscle tenderness, shoulder/hip bursitis, and/or oligoarthritis.
More common in women.
About 15% to 20% of patients with PMR have giant cell arteritis (GCA); 40% to 60% of GCA patients have PMR.
Diagnosis is made via history and with supportive laboratory tests indicating an elevated ESR or CRP.
Rapid improvement often occurs within 24 to 72 hours with low-dose prednisolone.
Polymyalgia rheumatica (PMR) is an inflammatory rheumatological syndrome that manifests as pain and morning stiffness involving the neck, shoulder girdle, and/or pelvic girdle in individuals older than age 50 years. Peripheral musculoskeletal involvement may also be present. PMR occurs either as an isolated condition or associated with giant cell arteritis.
History and exam
Key diagnostic factors
- presence of risk factors
- shoulder/hip girdle stiffness
- shoulder/hip girdle pain
- rapid response to corticosteroids
Other diagnostic factors
- acute onset
- low-grade fever
- weight loss
- oligoarticular arthritis
- age ≥50 years
- giant cell arteritis (GCA)
- female sex
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
Investigations to consider
- serum protein electrophoresis
- rheumatoid factor
- anti-cyclic citrullinated peptide antibodies
- interleukin (IL)-6
- fluorodeoxyglucose F-18 PET scan
treatment-resistant or relapse or disease exacerbation
- Giant cell arteritis (GCA)
- Early rheumatoid arthritis (RA)
- 2015 recommendations for the management of polymyalgia rheumatica
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