The white blood cell count may be normal or mildly elevated. Platelet counts are often increased. Alkaline phosphatase may be mildly increased. Serum albumin levels may be slightly decreased. Radiography of painful joints may rarely show abnormalities such as osteopenia, joint space narrowing, or erosions. Magnetic resonance imaging MRI is not necessary for diagnosis, but MRI of the shoulder reveals subacromial and subdeltoid bursitis and glenohumeral joint synovitis in the vast majority of patients. MRI of the hands and feet demonstrates inflammation of the tendon sheaths in many patients.
Ultrasonography is very operator dependent but may be useful when the diagnosis is uncertain. Bursa ultrasonography may reveal an effusion within the shoulder bursae.
The ultrasonography findings and those of MRI usually correlate well. Why is this test important? Patients should be monitored for symptoms or signs of arteritis after treatment initiation, because low-dose corticosteroids such as prednisone do not prevent progression of PMR to GCA. If clinical signs of vasculitis develop, TAB should be performed. TAB may also be warranted in patients with PMR who are receiving low-dose corticosteroids if the clinical response is incomplete or if the ESR remains elevated or rises despite symptom resolution on corticosteroid therapy.
The goals of therapy in PMR are to control painful myalgia, to improve muscle stiffness, and to resolve constitutional features of the disease. Oral corticosteroids such as prednisone see sidebar are the first line of treatment. Nonsteroidal anti-inflammatory drugs NSAIDs may be helpful as adjuncts to corticosteroids during tapering, or alone in mild cases.
PMR is usually a self-limiting disease. If untreated, patients will have an impaired quality of life.
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With early diagnosis and correct therapy, patients have an excellent prognosis. The average length of disease is 3 years.
Generally, PMR is not associated with serious complications; however, patients treated with corticosteroids are at risk for long-term complications of corticosteroid therapy. Every patient should be considered at risk for GCA. Corticosteroids are considered the treatment of choice because they often cause complete or near-complete symptom resolution and reduction of the ESR to normal.
However, they do not cure the disease. The low-dose corticosteroids used in PMR are almost certainly ineffective in the prevention of vasculitis progression. Nevertheless, controversy remains regarding the dose and duration of treatment. The dose should be increased if symptoms are not well controlled within 1 week, and a diagnosis of GCA may need to be pursued. In contrast to results with other rheumatic diseases, alternate-day administration of corticosteroids in PMR has been largely unsuccessful. NSAIDs may provide supplemental pain relief.
Polymyalgia Rheumatica: Symptoms, Tests, and Treatment
They may be used alone in the treatment of patients with mild symptoms; however, most patients require corticosteroids for total control of symptoms. Methotrexate, azathioprine, and other immunosuppressive therapies are seldom used in PMR treatment. Occasionally, they may be considered in patients with corticosteroid intolerance or as corticosteroid-sparing agents. In fact, symptomatic palliation of pain with analgesic therapy alone may be preferable in patients with intolerable adverse effects from corticosteroids e.
PMR requires a primary care physician, rheumatologist, ophthalmologist, pathologist, and surgeon on an as-needed basis.
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Both the primary care physician and the rheumatologist play an important role in diagnosis, treatment, and follow-up care. Consultation with an ophthalmologist is important if concomitant GCA causes decreased vision. PMR is typically treated in an outpatient setting. Patients receiving steroids should have monthly follow-up, with regular monitoring of the ESR. An isolated increase of the ESR without symptoms during the course of treatment is not a valid reason to increase the corticosteroid dose; however, a temporary delay in dose reduction may be necessary.
After steroid tapering, follow-ups can be performed quarterly. Because relapses are more likely to occur during the initial 18 months of therapy and within 1 year of corticosteroid withdrawal, all patients should be monitored for symptom recurrence throughout corticosteroid tapering and until 12 months after cessation of therapy. Polymyalgia rheumatica and giant-cell arteritis.
Polymyalgia rheumatica. Developing classification criteria for polymyalgia rheumatica: comparison of views from an expert panel and wider survey. J Rheumatol. Dasgupta B, Hassan N. Giant cell arteritis: recent advances and guidelines for management. Clin Exp Rheumatol.
Management guidelines and outcome measures in polymyalgia rheumatica PMR. May 17, Pain or aching is usually felt in the large muscle groups, especially around the shoulders and hips. Cleveland Clinic is a non-profit academic medical center.
What is polymyalgia rheumatica (PMR) and whom does it affect?
Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Polymyalgia Rheumatica PMR and Giant Cell Arteritis GCA Polymyalgia rheumatic, which causes pain in major muscle groups, and giant cell arteritis, a disorder of inflamed arteries also called temporal arteritis, often affect people older than 50, more women than men, and more Caucasians than other ethnic groups.
Can other problems be confused with polymyalgia rheumatica PMR? Other illnesses that may be confused with PMR include: Rheumatoid arthritis Infections such as the flu Inflammation of blood vessels vasculitis Metabolic chemical and hormone abnormalities A variety of muscle diseases Cancer and many other diseases What causes polymyalgia rheumatica PMR and giant cell arteritis GCA?
Latest Advances in the Diagnosis and Treatment of Polymyalgia Rheumatica
The exact cause of these illnesses is unknown. What are the symptoms of giant cell arteritis GCA? How often do they occur? The large blood vessels may become narrowed or enlarged aneurysm ; see figure.
If narrowing occurs in the blood vessels leading to the arms or legs, patients may notice fatigue or aching in the limbs because of a reduced blood supply.