POLYMYALGIA RHEUMATICA 

Polymyalgia rheumatica (PMR) is a relatively common cause of widespread aching  and stiffness in older adults. It can be difficult to diagnose because it rarely causes swollen joints or other abnormalities on physical exam. It may occur with another condition, giant cell arteritis. 

Fast facts 

• PMR affects adults over the age of 50. 
• The symptoms of PMR are aching and stiffness, worst on arising in the morning, affecting  the upper arms,  neck, buttocks, and thighs. 
• Symptoms usually respond promptly and completely to low doses of corticosteroids. 

What  is polymyalgia rheumatica? 

The typical symptoms of polymyalgia rheumatica (PMR) are aching and stiffness around  the upper arms, neck, lower back and thighs. Symptoms tend to develop quickly, over  a period of several days or weeks,  and occasionally even overnight. Both sides of the body are affected. Involvement of the upper arms, with difficulty raising them above the shoulders, is especially common. 

Aching and stiffness are worse in the morning, and tend to improve gradually as the day goes by, but periods of inactivity, such as a long car ride or sitting too long in one position, will cause stiffness to return. Stiffness  may be so severe that there is pain at night, difficulty getting dressed  in the morning (for example, putting  on a jacket or bending over to pull on socks and shoes), or difficulty getting up from a low chair. Occasionally, aching occurs in distal joints such as those of the hands and wrists. 

What causes  polymyalgia rheumatica? 

The cause of PMR  is unknown. The tendency for symptoms to begin abruptly suggests the possibility of  an infection but, so far, no specific infection has been found. “Myalgia” comes from the Greek word for “muscle pain,” but tests for muscle damage,  such as enzymes (a type of blood test) to actual biopsy, are all normal. 

Recent evidence now suggests  that PMR  is an arthritis with a particular tendency to involve the shoulder and hip joints, and the bursae (or sacs) around these joints. Thus, the pain  in the upper arms  and thighs thus comes from  the nearby shoulder and hip joints. PMR should not be confused with a condition called fibromyalgia, a condition that affects mainly younger adults and is not a form of arthritis. 

Who gets polymyalgia rheumatica? 

PMR occurs only in older adults, and rarely in people younger than 50.  The average age  of onset of symptoms is 70, and many people who have PMR  are in their 80s or even older. Women are affected somewhat more often than men, and the disease is more frequent in whites than nonwhites,  but all races are susceptible. PMR  is not unusual – in fact, it is diagnosed for  the first time in older adults more frequently than rheumatoid arthritis.