polymyalgia rheumatica

Polymyalgia Rheumatica (PMR): A Comprehensive Overview

Polymyalgia rheumatica (PMR) is a chronic inflammatory condition that affects the muscles and joints, causing widespread pain and stiffness. The symptoms of PMR are typically characterized by:

• Pain and stiffness: PMR causes severe pain and stiffness in the muscles of the neck, shoulders, hips, and upper arms [1][2].
• Muscle inflammation: The condition involves inflammation of the lining of joints, leading to muscle pain and stiffness [3][4].
• Symmetrical symptoms: PMR often affects both sides of the body simultaneously, with symptoms typically occurring in the proximal muscle groups, including the shoulder, pelvic girdle, and neck [5].

The exact cause of PMR is unknown, but it is believed to be related to an autoimmune response, where the immune system mistakenly attacks healthy tissues. The condition is more common in people over 50 years old and is often associated with other inflammatory conditions, such as giant cell arteritis.

Common symptoms of PMR:

• Pain and stiffness in the muscles of the neck, shoulders, hips, and upper arms
• Fatigue and depression
• Low-grade fever
• Muscle tenderness

If you're experiencing any of these symptoms, it's essential to consult with a healthcare professional for an accurate diagnosis and treatment plan.

References:

[1] Context result 7: Polymyalgia rheumatica causes muscle pain and stiffness in the shoulders, upper arms, hip area, and sometimes the neck.

[2] Context result 3: Symptoms like pain and stiffness are common in PMR.

[3] Context result 8: Inflammation of the lining of joints is a characteristic feature of PMR.

[4] Context result 9: Pain and stiffness around the neck, shoulder, and hip area are typical symptoms of PMR.

[5] Context result 10: Proximal muscle groups, including the shoulder, pelvic girdle, and neck, are commonly affected in PMR.

Common Signs and Symptoms of Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is a form of inflammatory arthritis that affects the muscles, causing pain and stiffness in various parts of the body. The most common symptoms of PMR include:

• Widespread Aching and Stiffness: Pain and stiffness in the shoulders, neck, hips, and thighs are the hallmark symptoms of PMR.
• Fatigue: Feeling extremely tired or exhausted is a common symptom of PMR.
• Loss of Appetite: Many people with PMR experience a decrease in appetite, leading to weight loss.
• Swelling of Hands or Wrists: Swelling and inflammation in the hands and wrists can occur in some cases.

These symptoms can come on quickly, even overnight, and are often accompanied by flu-like symptoms such as low-grade fever, weakness, and sweating. In rare cases, permanent muscle weakness, degeneration, and loss (atrophy) of muscle mass, and disability may occur.

References:

• [1] Fatigue. ; Loss of appetite. ; Swelling of your hands or wrists. (Search Result 1)
• [2] The most common symptoms of polymyalgia rheumatica are widespread aching and stiff muscles. Symptoms can come on quickly, even overnight. Usually, you feel ... (Search Result 2)
• [3] Symptoms. Polymyalgia rheumatica can cause pain and stiffness in the shoulders, neck, hips and thighs. Polymyalgia rheumatica often comes on quickly, ... (Search Result 3)
• [4] Flu-like symptoms, including low-grade fever, weakness, loss of appetite, ... (Search Result 5)
• [7] high temperature (fever) and sweating · extreme tiredness (fatigue) · loss of appetite · weight loss ... (Search Result 7)
• [9] Fatigue, depression, night sweats, loss of appetite, weight loss, and low-grade fever may also occur in patients with PMR. Polymyalgia ... (Search Result 9)

Diagnostic Tests for Polymyalgia Rheumatica

Polymyalgia rheumatica (PMR) is a condition that causes muscle pain and stiffness, particularly in the shoulders, neck, and hips. While there's no specific test to diagnose PMR, various diagnostic tests can help determine if you have this condition.

Physical Exam A physical exam, including joint and neurological exams, can help your doctor determine the cause of your pain and stiffness [1]. This is often the first step in diagnosing PMR.

Blood Tests Several blood tests are commonly used to diagnose PMR. These include:

• Erythrocyte sedimentation rate (ESR) or "sed" rate: This test measures inflammation in the body, which can be elevated in people with PMR [2].
• C-reactive protein (CRP): Like ESR, CRP is a blood test that measures inflammation in the body [3].
• Plasma fibrinogen assays: Elevated plasma fibrinogen levels have been recommended for diagnosing active PMR [4].

Other Tests While not specific to PMR, other tests may be ordered to rule out other conditions. These include:

• Blood pressure checks
• Regular check-ups if you're taking a DMARD (disease-modifying antirheumatic drug)

Diagnosis Based on Medical History and Symptoms A diagnosis of polymyalgia rheumatica is primarily based on the patient's medical history, symptoms, and physical examination. No single test is available to definitively diagnose PMR [5].

References: [1] Context 1 [2] Context 2 [3] Context 2 [4] Context 9 [5] Context 7

Treatment Overview

Polymyalgia rheumatica (PMR) is typically treated with medications to alleviate symptoms and manage the condition. The primary goal of treatment is to reduce inflammation, relieve pain, and improve quality of life.

Medications Used in PMR Treatment

• Corticosteroids: These are the mainstay of treatment for PMR. A low dose of corticosteroids, such as prednisolone, is usually prescribed to help ease symptoms.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Medications like ibuprofen and naproxen can be used in conjunction with corticosteroids or as an alternative for some patients. They work by reducing inflammation and pain.
• Steroid-sparing medications: In some cases, medications like methotrexate may be recommended to reduce the need for long-term corticosteroid use.

Treatment Guidelines

• The initial treatment for PMR typically involves a low dose of corticosteroids (10-15 mg per day).
• Treatment with glucocorticoids is recommended for all patients diagnosed with PMR.
• Biologics, such as sarilumab (Kevzara), have been approved for the treatment of PMR in adults.

Treatment Outcomes

• Studies have shown that corticosteroid treatment can lead to significant improvements in symptoms and quality of life for patients with PMR.
• The use of steroid-sparing medications, such as methotrexate, may also help reduce the risk of long-term complications associated with corticosteroid use.

References

• [1] Steroid medicine is the main treatment for polymyalgia rheumatica (PMR). A type of steroid called prednisolone is usually prescribed. (Source: Search Result 2)
• [3] Naproxen is indicated for relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, ... (Source: Search Result 3)
• [4] Methotrexate is currently recommended by both international4 and local guidelines16 as the first-line steroid-sparing drug to consider in ... (Source: Search Result 4)
• [6] Polymyalgia rheumatica treatment begins with a low dose of corticosteroids. Your healthcare provider may recommend 10 mg (milligrams) to 15 mg per day of ... (Source: Search Result 6)
• [7] Initial treatment with low-dose glucocorticoids is recommended for all patients diagnosed with polymyalgia rheumatica (PMR) (Source: Search Result 7)
• [9] Sarilumab (Kevzara), an interleukin-6 receptor inhibitor, was approved by the US Food and Drug Administration (FDA) in February 2023 for adults ... (Source: Search Result 9)

Note: The above information is based on the search results provided and may not be a comprehensive or definitive guide to PMR treatment. It's essential to consult with a healthcare professional for personalized advice and care.

Polymyalgia Rheumatica (PMR) is a condition characterized by muscle pain and stiffness, particularly in the shoulders, neck, and hips. When diagnosing PMR, it's essential to consider several differential diagnoses that can present with similar symptoms.

Common Differential Diagnoses:

• Hypothyroidism: A thyroid disorder that can cause muscle pain, stiffness, and fatigue [2][3].
• Fibromyalgia: A chronic condition characterized by widespread muscle pain, fatigue, and tender points [3][9].
• Late-onset rheumatoid arthritis (LORA): A type of arthritis that can cause joint pain, stiffness, and swelling in older adults [8].
• Polymyositis/dermatomyositis: Inflammatory muscle diseases that can cause muscle weakness, pain, and skin rashes [8].
• Bursitis/tendonitis: Inflammation of the fluid-filled sacs (bursae) or tendons surrounding joints, which can cause pain and stiffness [9].

Other Considerations:

• Rotator-cuff diseases: Conditions affecting the rotator cuff muscles and tendons in the shoulder joint, such as tears or tendinopathy [9].
• Adhesive capsulitis: A condition characterized by inflammation of the shoulder joint capsule, leading to pain and stiffness [9].
• Degenerative joint disease: Wear and tear on joints due to aging, which can cause pain and stiffness [9].

Key Diagnostic Features:

A diagnosis of PMR should be considered in patients aged >50 years who have sub-acute to acute onset of bilateral shoulder pain and stiffness [7]. It's essential to rule out other conditions that may present with similar symptoms.

References:

[1] Mar 3, 2023 — Differential Diagnoses · AA (Inflammatory) Amyloidosis · Depression · Fibromyalgia · Giant Cell Arteritis (Temporal Arteritis) · Hypothyroidism. [2] by TL CAYLOR · 2013 · Cited by 52 — Differential Diagnosis of Polymyalgia Rheumatica; Muscle stiffness or pain · Thyroid disorders (hypothyroidism or thyrotoxicosis), Systemic ... [3] by S Acharya · 2022 · Cited by 10 — Differential Diagnosis · Crown dens syndrome [51] · Hypothyroidism · Obstructive sleep apnea · Depression · Viral infections such as EBV, hepatitis, ... [4] by C Salvarani · Cited by 4 — GRAPHICS · - Patient with PMR · - Hand swelling and edema in PMR · - Remitting seronegative symmetrical synovitis with pitting edema. [5] by T Nothnagl · 2006 · Cited by 37 — Polymyalgia rheumatica (PMR) is a common disorder in the elderly population. The diagnosis is based upon recognition of a clinical syndrome, consisting of pain ... [6] Nov 16, 2020 — The primary differential diagnosis in the two presented cases is polymyalgia rheumatica or rheumatoid arthritis. There are many similar features ... [7] A diagnosis of PMR should be considered in patients aged >50 years who have sub-acute to acute onset of bilateral shoulder pain and stiffness. · Any patient with ... [8] by T Nothnagl · 2006 · Cited by 37 — 4.2 Differential Diagnosis · Late-onset rheumatoid arthritis (LORA). · Hypothyroidism. · Fibromyalgia. · Tumour. · Polymyositis/dermatomyositis. · Bursitis/tendonitis ... [9] Differential Diagnosis[edit | edit source] · Rotator-cuff diseases (rotator cuff tears, rotator cuff tendinopathy) · Adhesive capsulitis · Degenerative joint ...