Condition: Polymyalgia Rheumatica (PMR)
Brief Overview: Polymyalgia rheumatica is an inflammatory condition characterized by muscle pain and stiffness, primarily in the shoulders, neck, and hips. Symptoms are often worse in the morning and improve with activity or after treatment with corticosteroids.
Prevalence: PMR affects approximately 0.5-1% of people over the age of 50, with higher prevalence in women and individuals of Northern European descent.
Etiology: The exact cause is unknown but may involve autoimmune mechanisms and genetic predisposition. Environmental factors, such as infections, may act as triggers.
Risk Factors:
• Age (primarily affects individuals over 50)
• Female sex
• Genetic predisposition (e.g., HLA-DR4 association)
• Northern European ancestry
Commonly Associated Conditions:
• Giant cell arteritis (temporal arteritis)
• Osteoporosis (due to long-term corticosteroid use)
• Depression due to chronic pain
Common Medications:
• Low-dose corticosteroids (e.g., prednisone) for inflammation control
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for mild symptoms
• Calcium and vitamin D supplements to prevent corticosteroid-induced bone loss
Common Labs, Imaging, and Tests:
• Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for inflammation markers
• Complete blood count (CBC) to assess for anemia of chronic disease
• Imaging (e.g., ultrasound or MRI) to evaluate bursitis or synovitis
Common Symptoms:
• Symmetrical pain and stiffness in the shoulders, neck, and hips. May start unilateral but usually moves to be symmetrical quickly
• Pain is typically rapid in onset
• Difficulty rising from chair or combing hair (proximal muscle involvement) or putting on clothes like shirt or coat
• Nighttime pain
• Morning stiffness lasting more than 30 minutes
• Fatigue and general malaise
• Low-grade fever in some cases
Common Treatments:
• Corticosteroids for rapid symptom relief
• Gradual tapering of corticosteroids based on symptom resolution and inflammation markers
• Physical therapy to maintain mobility and function
Physical Findings:
• Tenderness over the shoulders and hips
• Limited range of motion in affected areas
• No significant muscle weakness on strength testing
Potential Complications and Contraindications:
• Risk of developing giant cell arteritis (GCA), which can cause vision loss
• Long-term corticosteroid use complications (e.g., osteoporosis, diabetes, infections)
• NSAID contraindications in patients with gastrointestinal or cardiovascular risks
General Health and Lifestyle Guidance:
• Encourage weight-bearing exercises to maintain bone health
• Promote a diet rich in calcium and vitamin D
• Advise on strategies to reduce corticosteroid side effects (e.g., monitoring blood pressure, glucose levels)
• Maintain regular follow-ups to adjust treatment and monitor for GCA symptoms
Suggested Questions to Ask Patients:
• Have you experienced stiffness or pain in the shoulders, neck, or hips?
• Are your symptoms worse in the morning or after periods of inactivity?
• Have you noticed headaches or changes in vision?
• Do you have any difficulty with daily tasks, such as dressing or standing?
Suggested Talking Points:
• Explain the typical symptoms of PMR and the role of inflammation.
• Reassure patients that symptoms typically respond well to corticosteroid treatment.
• Discuss the importance of monitoring for symptoms of giant cell arteritis and see doctor immediately if any occur (headache, visual loss, diplopia).
• Highlight lifestyle modifications to mitigate the risks of long-term corticosteroid use. These would include exercise and avoiding sugar and simple carbohydrates.
• Warn against abruptly stopping steroids.