Polymyalgia Rheumatica (PMR) is an autoinflammatory condition in people over 50 years of age (highest risk age 70–80) presenting with stiffness in hips and shoulders. Early diagnosis and treatment will produce fast symptom relief and prevent disability.
What is Polymyalgia Rheumatica?
Polymyalgia Rheumatica is an autoimmune disease. It causes inflammation in the joints, tendons and muscles of the shoulders and hips. Patients notice either a gradual or sudden difficulty turning over in bed or getting up from lying or sitting positions. Movement makes the stiffness better, and it also improves later in the day.
People also feel more tired and can have a reduced appetite.
PMR is sometimes associated with blood vessel inflammation (Giant Cell Arteritis – GCA – which is a form of large vessel vasculitis) causing temporal headache, jaw stiffness or visual disturbance. This association is a medical emergency as it can cause sudden and potentially irreversible visual loss.
What are the symptoms of Polymyalgia Rheumatica?
Common symptoms include:
- Fatigue
- Stiffness and pain in shoulder, hips and neck, especially in the mornings
- Difficulty using affected joints
- Low-grade fever
- Reduced appetite
- Reduced mobility
- If headache, jaw stiffness or visual disturbance are experienced, this is a medical emergency
What causes Polymyalgia Rheumatica?
The exact cause of polymyalgia rheumatica is not known. Researchers believe PMR may develop because of a combination of:
- Genetic factors
- Immune system changes
- Environmental triggers such as sun exposure and viruses
How do we diagnose polymyalgia rheumatica?
Dr Nuttall will take the time to understand your symptoms, medical history, and overall health before recommending targeted investigations. Evaluation will include:
- A detailed discussion of medical history
- A physical examination
Tests may include:
- Blood tests that look for signs of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
- Autoimmune markers – Rheumatoid factor (RF) and Anti-CCP antibody – to exclude other causes of symptoms
- X-rays, ultrasound imaging and MRI scanning may be requested to exclude other causes, but are often not needed if the clinical history and blood tests are conclusive
- Bone density scan (DEXA), blood tests for blood sugars and cholesterol to help mitigate treatment side effects
Polymyalgia rheumatica treatment and management:
Treatment aims to stop inflammation and will usually continue for 12–24 months, as shorter treatment courses often result in disease relapse.
Treatment plan
Your treatment plan may include:
- Steroids (usually oral Prednisolone) are the mainstay of treatment and start at a higher dose of 20–30mg, to be reduced slowly over 12–24 months. They produce fast symptom relief within 24–48 hours.
- DMARDs (Methotrexate and Leflunomide) are sometimes used when steroids are not sufficient or the dose cannot be reduced without causing symptom relapse.
- Biologic medications are not currently licensed in the UK for use in PMR unless there is an overlap with GCA.
- Bone protection medication such as bisphosphonates (oral Alendronic Acid or intravenous Zolendronic Acid), Denosumab, or osteoanabolic agents (Teriparatide, Abaloparatide or Romosozumab) are used to mitigate bone loss caused by steroid use.
- Treatment for increases in blood pressure, blood sugars and cholesterol may also be required.
Dr Nuttall will tailor treatment to reduce inflammation, improve mobility, and support long-term joint health.
