What is polymyalgia rheumatica and who does it affect?

Polymyalgia rheumatica (PMR) is a condition which causes inflammation of large muscles. ‘Poly’ means many, and ‘myalgia’ means muscle pain. The cause is not known. PMR mainly affects people over the age of 60. It is rare in people under 50. About 3 in 10,000 people over the age of 50 develop PMR each year. Women are three times more likely to be affected than men.

What are the symptoms of polymyalgia rheumatica?

• Usual symptoms are stiffness, pain, aching, and tenderness of the large muscles around your shoulders, pelvis, and back. The stiffness is usually worst first thing in the morning. Getting out of bed may be difficult. The stiffness often eases as the day goes on.
• Inflammation and swelling sometimes occurs in other ‘soft tissues’ of the body. For example, tendons may become inflamed (tenosynovitis), your hands or feet may become slightly swollen, and some joints may become slightly swollen.
• Other general symptoms may also occur. These include: tiredness, depression, night sweats, fever, loss of appetite, and weight loss. Symptoms typically develop over a few days or weeks. However, they develop more slowly in some cases. You may pass it off as ‘aches and pains of getting older’ when symptoms first start.

  Do I need any tests?

  

  Symptoms of PMR are sometimes similar to other conditions such as frozen shoulder, arthritis, or other muscle diseases. A blood test helps to make the correct diagnosis. No blood test is 100% reliable for PMR. However, a blood test can detect if there is inflammation in your body. If the blood test shows a high level of inflammation, and you have the typical symptoms, then this usually confirms the diagnosis of PMR.

  What is the treatment for polymyalgia rheumatica?

  

  A steroid medicine such as prednisolone is the usual treatment. Steroids work by reducing inflammation. Treatment usually works quickly, within a few days. The improvement in symptoms over 2-3 days is often quite dramatic.

  Treatment is usually started with a medium dose – usually about 15 mg per day. This is then reduced gradually to a low ‘maintenance’ dose. It may take several months to gradually reduce the dose. The maintenance dose needed varies from person to person. Usually it is between 5 and 8 mg. The low dose of steroids taken each day keeps symptoms away in most cases.

  You are likely to need treatment for at least two years. In some people the condition goes away, so the tablets can be stopped after 2-3 years. However, many people need treatment for several years, sometimes for life. If you stop taking the steroid medicine too soon, the symptoms return.

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