Polymyalgia Rheumatica (PMR)

PMR is a large vessel vasculitis with different disease manifestations but along the same spectrum of disease as Giant Cell Arteritis

Symptoms:

• Morning stiffness - at least 30 minutes, usually located in the hip and shoulder girdle.  Patients may particularly endorse difficulty with getting dressed (putting on shirt, fastening bra, combing hair, putting on pants).
• Pain: shoulder pain present in 70-95%, hip and neck in 50-70%
• Synovitis and bursitis, swelling, tenosynovitis (carpal tunnel syndrome)
• Decreased ROM – typical in the shoulders, neck, and hips
• Subjective weakness:  usually a normal exam but can have secondary weakness due to pain and disuse atrophy.  Despite the name, muscle involvement is not typical.
• Systemic  symptoms of inflammation: malaise, fatigue, depression, anorexia, weight loss

Treatment:

• Steroids with slow taper.  Hallmark of the disease is that patient respond dramatically and quickly to 10-20mg prednisone.  Relatively low dose with tapering of 2.5mg weekly.
• Recurrence common.  Can follow disease activity by symptoms and serial ESRs
• Methotrexate as steroid sparing agent used in patients who cannot be tapered of prednisone without flares.

(Meghan Ramsey MD, 6/8/11)