PMR

Polymyalgia rheumatica (PMR) is an inflammatory condition that primarily affects adults over 50, causing proximal muscle pain and stiffness, especially in the shoulder and hip girdles. Many patients also experience systemic symptoms such as fatigue, weight loss, or low-grade fever. PMR is one of the most common inflammatory rheumatic diseases in older adults.

Most cases occur after age 50 with a female predominance and higher incidence in people of Northern European descent. The exact cause is unknown, but genetic factors (such as HLA-DRB1 alleles) and environmental triggers are suspected. Inflammatory markers are typically elevated, including C-reactive protein and the erythrocyte sedimentation rate; anemia of chronic disease may be present. PMR and giant cell arteritis (GCA) are related conditions, and about 10-20% of PMR patients develop GCA.

Clinical features include symmetric shoulder and hip girdle pain and stiffness that is worst in the morning and lasts more than 30 minutes, with reduced range of motion. Diagnosis is clinical, supported by raised ESR or CRP and often normal creatine kinase, which helps distinguish PMR from inflammatory myopathies. Imaging, such as ultrasound or MRI, can aid in excluding other causes but is not essential.

Treatment relies on glucocorticoids. A low-to-moderate dose of prednisone (typically 12.5–25 mg daily) usually yields rapid improvement within days. A gradual taper over 12 to 24 months is common, with monitoring for relapses and corticosteroid-related side effects. In resistant cases, or to spare steroids, agents such as methotrexate or tocilizumab may be considered.

Prognosis is generally favorable with treatment, though relapses are common and long-term steroid exposure carries risks. Ongoing monitoring for GCA symptoms is important due to overlap; new headaches, jaw claudication, or vision changes warrant prompt evaluation.