Overview
Definition
An inflammatory rheumatic condition characterized by aching and morning stiffness in the shoulders, neck, and pelvic girdle.
Epidemiology
Almost exclusively affects individuals > 50 years old.
Etiology & Risk Factors
- Unknown autoimmune trigger. Highly associated with Giant Cell Arteritis (Temporal Arteritis) - about 15-20% of patients with PMR will develop GCA.
Clinical Symptoms
- Bilateral, severe aching and stiffness in the shoulders, neck, and hips/pelvis
- Stiffness is worst in the morning (lasting > 45 minutes) and after periods of rest ('gel phenomenon')
- Patients have difficulty getting out of a chair or lifting their arms above their head
- NO objective muscle weakness (strength is normal, pain limits movement)
Clinical Approach
Diagnosis
- Clinical diagnosis
- Inflammatory markers: ESR and CRP are markedly elevated
- Must explicitly ask about symptoms of Giant Cell Arteritis (headache, jaw claudication, visual changes)
Management
- Low-dose Corticosteroids (e.g., Prednisone 15-20mg daily)
- Response to steroids is typically RAPID and DRAMATIC (symptoms resolve within 24-48 hours; if they don't, question the diagnosis)
- Usually requires a slow taper over 1-2 years
Complications
- Significant impairment of daily activities if untreated
- Development of Giant Cell Arteritis (which can cause irreversible blindness if missed)