Polymyalgia rheumatica
Classification and external resources
In polmyalgia rheumatica (PMR), pain is usually located in the shoulders and hips.
ICD-10	M35.3
ICD-9	725
MedlinePlus	000415
eMedicine	emerg/473
MeSH	D011111

Polymyalgia rheumatica (meaning "pain in many muscles" in Greek), abbreviated as PMR, is an inflammatory condition of the muscles, which causes pain or stiffness, usually in the neck, shoulders, and hips. The pain can be very sudden, or can occur gradually over a period of time.

Most PMR sufferers wake up in the morning with pain in their muscles; however, there have been cases in which the patient has developed the pain during the evenings.^[1] Patients who have polymyalgia rheumatica may also have temporal arteritis, a potentially dangerous inflammation of blood vessels in the face]]. PMR usually goes away within a year or two after treatment.^[2]

PMR is usually treated with long courses of oral steroid.

Contents 1 Symptoms and signs 2 Causes 3 Diagnosis 4 Treatment 5 Epidemiology 6 See also 7 References 8 External links

[edit] Symptoms and signs

There is a wide range of symptoms that indicate if a person has polymyalgia rheumatica. The symptoms include pain and stiffness in the muscles, usually in the neck, shoulders, and hips. The pain is moderate to severe, and may inhibit the activity of the person. These symptoms usually occur in the morning, or after sleeping. Fatigue and lack of appetite are also indicative of polymyalgia rheumatica. Lack of appetite could lead to unintentional weight loss. Anemia is another sign of polymyalgia rheumatica. An overall feeling of illness and a slight fever are commonly seen.^[2]

Studies have shown that about 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis, and about 50% of people with temporal arteritis have polymyalgia rheumatica. Some symptoms of temporal arteritis include severe headaches, scalp tenderness, jaw or facial soreness, distorted vision or aching in the limbs caused by decreased blood flow, and fatigue.^[1]

[edit] Causes

The cause of this disorder is unknown; and during this disorder, the white blood cells in the body attack the lining of the joints, causing inflammation.^[2] Recent studies have found that inherited factors also play a role in the probability that an individual will become sick with polymyalgia rheumatica. Several theories have included viral stimulation of the immune system in genetically susceptible individuals.^[3] Several viruses are thought to be linked to polymyalgia rheumatica, including the adenovirus, which causes respiratory infections; the human parvovirus B19, an infection that affects children; and the human parainfluenza virus.^[2]

[edit] Diagnosis

There is no specific test to diagnose polymyalgia rheumatica. There are many other diseases which cause inflammation and pain in muscles, but there are a few tests that can help narrow down the cause of the pain. Limitation in shoulder motion, or swelling of the joints in the wrists or hands are noted by the doctor.^[3] The doctor will assess the patient’s pain, and may perform one of the following tests to determine if polymyalgia rheumatica is indeed the cause of the pain.^[2]

One blood test that is usually performed is the erythrocyte sedimentation rate (ESR) which measures how fast the patient's red blood cells settle in a test tube. The faster the blood cells settle, the higher the ESR value, which means that there is inflammation. Many conditions can cause an elevated ESR, so this test alone is not proof that a person has polymyalgia rheumatica.^[2]

Another test that checks the level of C-reactive protein (CRP) in the blood may also be conducted. CRP is produced by the liver in response to an injury or infection and people with polymyalgia rheumatica usually have high levels.^[2] However, like the ESR, this test is also very non-specific.

Polymyalgia rheumatica is sometimes associated with temporal arteritis, a condition requiring more aggressive therapy. To test for this additional disorder, a biopsy sample may be taken of the temporal artery.^[2]

[edit] Treatment

Prednisone is the drug of choice for PMR. Start does of 15 mg / d is recommended with a taper rate of about 1 mg / month^[4] resulting in a treatment duration of greater than one year.^[3]

Anti-inflammatory medicine such as ibuprofen are not useful.^[5]

Along with medical treatment, patients are encouraged to exercise and eat healthily. Exercise will help strengthen the weak muscles, and help to prevent weight gain. A healthy diet will help to keep a strong immune system, and also help build strong muscles and bones.^[2]

[edit] Epidemiology

There are no certain circumstances for which an individual will get polymyalgia rheumatica, but there are a few factors that show a relationship with the disorder.

• Usually affects adults over the age of 50^[1]
• The average age of a person who has PMR is about 70 years old^[1]
• Women are twice as likely to get PMR as men^[1]
• The vast majority of people affected are white^[1]
• 50% of people with temporal arteritis also have polymyalgia rheumatica^[1]

[edit] See also

• Remitting seronegative symmetrical synovitis with pitting edema (RS3PE)

[edit] References

[edit] External links

• Mayo Clinic PMR factsheets

v • d • e Systemic CT disorders (M32-M36, 710) Mixed connective tissue disease Systemic lupus erythematosus: Drug-induced SLE · Libman-Sacks endocarditis Dermatopolymyositis/Inflammatory myopathy/Myositis: Dermatomyositis (Juvenile dermatomyositis) · Polymyositis · Inclusion body myositis Scleroderma: Systemic scleroderma (Progressive systemic sclerosis, CREST syndrome) Other hypersensitivity/autoimmune Sjögren's syndrome Other Behçet's disease · Polymyalgia rheumatica · Eosinophilic fasciitis · Eosinophilia-myalgia syndrome muscle, DF+DRCT navs: anat/hist/physio, acquired myopathy/congenital myopathy/neoplasia, symptoms+signs/eponymous, proc

v • d • e Soft tissue disorders / Rheumatism / Connective tissue arthropathy (M65-M79, 725-727) Capsular Synoviopathy Synovitis/Tenosynovitis (Calcific tendinitis, Stenosing tenosynovitis, Trigger finger, DeQuervain's syndrome) · Transient synovitis · Ganglion cyst osteochondromatosis (Synovial osteochondromatosis) · Plica syndrome villonodular synovitis (Giant cell tumor of the tendon sheath) Bursopathy Bursitis (Olecranon, Prepatellar, Trochanteric, Subacromial) · Synovial cyst (Baker's cyst) Noncapsular Fasciopathy Fasciitis: Plantar · Nodular · Necrotizing · Eosinophilic Fibromatosis/contracture Dupuytren's contracture · Peyronie's disease · Plantar fibromatosis · Aggressive fibromatosis · Knuckle pads Tendinopathy/ Enthesopathy/Enthesitis upper limb (Adhesive capsulitis of shoulder, Rotator cuff tear, Golfer's elbow, Tennis elbow) lower limb (Iliotibial band syndrome, Patellar tendinitis, Achilles tendinitis, Calcaneal spur, Metatarsalgia) · Bone spur other/general: Tendinitis · Tendinosis joint navs: anat, non-congenital arthropathies/deformities/dorsopathies/soft tissue arthropathy/congenital, eponymous signs, proc muscle, DF+DRCT navs: anat/hist/physio, acquired myopathy/congenital myopathy/neoplasia, symptoms+signs/eponymous, proc