Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is a relatively common condition seen in older people characterised by muscle stiffness and raised inflammatory markers. Whilst it appears to be closely related to temporal arteritis the underlying cause is not fully understood and it does not appear to be a vasculitic process.

Features

• typically patient > 60 years old
• usually rapid onset (e.g. < 1 month)
• aching, morning stiffness in proximal limb muscles
  • weakness is not considered a symptom of polymyalgia rheumatica
• also mild polyarthralgia, lethargy, depression, low-grade fever, anorexia, night sweats

Investigations

• raised inflammatory markers e.g. ESR > 40 mm/hr
• note creatine kinase and EMG normal

Treatment

• prednisolone e.g. 15mg/od
  • patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis