eMedicine Specialties > Emergency Medicine > Rheumatology

Polymyalgia Rheumatica

Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Contributor Information and Disclosures

Updated: Dec 4, 2009

Introduction

Background

Polymyalgia rheumatica (PMR) is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle. It is classified as a rheumatic disease, although the etiology is undetermined.

Pathophysiology

Polymyalgia rheumatica causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal. Some evidence suggests the presence of cell-mediated injury to the elastic lamina in the blood vessels in the affected muscle groups.

Polymyalgia rheumatica is closely linked to giant cell arteritis (temporal arteritis), but this is believed to be a separate disease process.1

Frequency

United States

One study revealed a prevalence of 1 in 200 people aged 50 years or older.

Mortality/Morbidity

Polymyalgia rheumatica is not a life-threatening disease, but it does require treatment for 2-4 years.

Race

Whites are affected more than other ethnic groups.

Sex

Females are affected twice as often as males.

Age

Polymyalgia rheumatica usually affects people older than 50 years.

Clinical

History

The patient's history may include the following features:

  • Pain and stiffness in the proximal muscle groups that usually is symmetrical and worse in the morning
  • Gel phenomenon (stiffness after prolonged inactivity)
  • Fever (low grade)
  • Weight loss
  • Fatigue
  • Depression
  • No weakness
  • Abrupt onset of symptoms

Physical

The signs and symptoms of polymyalgia rheumatica are nonspecific, and objective findings on physical examination often are lacking. If present, findings may include the following:

  • No muscle atrophy
  • Muscle tenderness
  • Decreased active range of motion of joints secondary to pain

Causes

The etiology of polymyalgia rheumatica is unknown; however, risk factors include the following:2,1

  • Age of 50 years or older
  • Presence of giant cell arteritis

More on Polymyalgia Rheumatica

Overview: Polymyalgia Rheumatica
Differential Diagnoses & Workup: Polymyalgia Rheumatica
Treatment & Medication: Polymyalgia Rheumatica
Follow-up: Polymyalgia Rheumatica
References
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References

  1. Dasgupta B, Matteson EL, Maradit-Kremers H. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol. Nov-Dec 2007;25(6 Suppl 47):130-6. [Medline].

  2. Salvarani C, Cantini F, Hunder GG. Polymyalgia rheumatica and giant-cell arteritis. Lancet. Jul 19 2008;372(9634):234-45. [Medline].

  3. Hernandez-Rodriguez J, Cid MC, Lopez-Soto A, Espigol-Frigole G, Bosch X. Treatment of polymyalgia rheumatica: a systematic review. Arch Intern Med. Nov 9 2009;169(20):1839-50. [Medline].

  4. Collier J. The management of polymyalgia rheumatica and giant cell arteritis. Drug Ther Bull. 1993;31:65-7.

  5. Epperly TD, Moore KE, Harrover JD. Polymyalgia rheumatica and temporal arthritis. Am Fam Physician. Aug 15 2000;62(4):789-96, 801. [Medline].

  6. Evans JM, Hunder GG. Polymyalgia rheumatica and giant cell arteritis. Rheum Dis Clin North Am. Aug 2000;26(3):493-515. [Medline].

  7. Gonzalez-Gay MA. Giant cell arteritis and polymyalgia rheumatica: two different but often overlapping conditions. Semin Arthritis Rheum. Apr 2004;33(5):289-93. [Medline].

  8. Kyle V, Hazleman BL. The clinical and laboratory course of polymyalgia rheumatica/giant cell arteritis after the first two months of treatment. Ann Rheum Dis. Dec 1993;52(12):847-50. [Medline].

  9. Michet CJ, Matteson EL. Polymyalgia rheumatica. BMJ. Apr 5 2008;336(7647):765-9. [Medline].

  10. Miller D, Allen SE, Walker SE. A primary care physician's guide to polymyalgia rheumatica. Primary Care Rep. 1998;4:91-100.

  11. Pipitone N, Salvarani C. Systemic vasculitis: state of the art and emerging concepts. Curr Opin Rheumatol. Jan 2006;18(1):1-2. [Medline].

  12. Rodnan GP, Schumacher HR. Polymyalgia rheumatic and temporal arteritis. In: Primer on the Rheumatic Diseases. 1990:76-7.

  13. Scientific American Editors. Systemic Vasculitis [book on CD-ROM]. 1995.

  14. Weyand CM, Goronzy JJ. Giant-cell arteritis and polymyalgia rheumatica. Ann Intern Med. Sep 16 2003;139(6):505-15. [Medline].

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Further Reading

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Contributor Information and Disclosures

Author

Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital
Geofrey Nochimson, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Summa Health System
Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gino A Farina, MD, Associate Professor of Clinical Emergency Medicine, Program Director, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine
Gino A Farina, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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