Polymyalgia Rheumatica (PMR) &
Giant Cell Arteritis (Temporal Arteritis)
Medical Author: William C. Shiel Jr., MD,
FACP, FACR
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is a disorder of the muscles and
joints characterized by pain and stiffness, affecting
both sides of
the body, and involving the shoulders, arms, neck, and buttock
areas.
Patients with polymyalgia rheumatica are typically over the age
of 50
years.
What causes polymyalgia rheumatica?
The cause of polymyalgia rheumatica is not known. Recent
research has
indicated that genetic (inherited) factors play a role in who
becomes
afflicted with the illness. Theories have included viral
stimulation of
the immune system in genetically susceptible individuals. Rarely, polymyalgia rheumatica is associated with a cancer. In this setting, the cancer may be initiating an inflammatory immune response to cause the polymyalgia rheumatica symptoms.
What are symptoms of polymyalgia rheumatica?
The onset of the illness can be sudden. A patient may have a
healthy
history until awakening one morning with stiffness and pain of
muscles and
joints throughout the body. These symptoms persist and are often
accompanied by an intense sensation of fatigue. Some patients
notice a
gradual loss of appetite, weight, and energy. Depression can
occur.
How is polymyalgia rheumatica diagnosed?
The doctor frequently notes muscle tenderness and that the
motion of the
shoulders is limited by pain. The joints are usually not
swollen. However,
swelling of the small joints of the hands, wrists, and/or knees
can occur.
Blood testing for inflammation is generally abnormal, as
indicated by a
significant elevation in the erythrocyte sedimentation rate
(ESR) and/or C-reactive protein. There
are no specific tests, however, for polymyalgia rheumatica and
X-rays are
normal. The diagnosis is based on the characteristic history of
persisting
muscle and joint pain and stiffness associated with
elevated blood tests for inflammation, such as the ESR. It is also not unusual for patients to have slight elevations of liver blood tests.
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