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Polymyalgia rheumatica

Definition and Epidemiology

  • Polymyalgia rheumatica (PMR) is an inflammatory disorder causing muscle pain and stiffness, primarily in the shoulders and hips.
  • Typically affects people over 50 years old, with a higher prevalence in women and individuals of Northern European descent.
  • Often associated with giant cell arteritis (GCA).

Pathophysiology

  • The exact cause is unknown, but it is believed to involve an abnormal immune response.
  • Genetic predisposition and environmental factors (possibly viral infections) are thought to contribute.
  • Inflammation primarily affects the synovial membrane, bursae, and tendons around joints.

Clinical Features

  • Sudden onset of pain and stiffness in the shoulders and hips.
  • Symptoms are worse in the morning and after periods of inactivity.
  • Associated fatigue, malaise, and mild fever.
  • In patients with concurrent GCA: headaches, visual disturbances, jaw claudication.

Diagnosis

  • Clinical diagnosis based on symptomatology and age.
  • Elevated inflammatory markers: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).
  • No specific diagnostic tests, but imaging may be used to rule out other conditions.
  • Response to low-dose corticosteroids is often considered diagnostic.

Management

  • Corticosteroids (prednisolone) are the mainstay of treatment, with rapid improvement in symptoms.
  • Gradual tapering of steroids based on symptoms and ESR/CRP levels.
  • Long-term management may require low-dose corticosteroid therapy for 1-2 years or longer.
  • Calcium and vitamin D supplementation to prevent steroid-induced osteoporosis.

Complications

  • Potential side effects of long-term corticosteroid use: osteoporosis, diabetes, hypertension, weight gain.
  • Increased risk of giant cell arteritis in patients with PMR.
  • Chronic pain and stiffness can lead to functional impairment.

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