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Overview

Polymyalgia Rheumatica (PMR) is an inflammatory disorder characterized by pain and stiffness in the shoulders, arms, neck and buttocks. It is commonly associated with another condition known as Giant cell arthritis (temporal arthritis).

Understanding the ailment

PMR occurs when immune cells of our body attack joints and muscles causing inflammation (result of immune reaction) in these sites leading to pain and stiffness. Viral infections are believed to trigger this immune response leading to PMR. But this type of immune reaction occurs only in certain individuals, those who have the HLA DR4 component in their blood cells. These individuals are said to be susceptible to PMR.

Probability

PMR is seen to occur in individuals above the age of 60 years (average age of developing PMR is 70 years), more commonly in women. 50% of people suffering from temporal arthritis have PMR.

Aging of bones and joints

Symptoms

All symptoms of PMR occur bilaterally that means both sides of the body are equally affected. Common symptoms include:

  • Aching pain around the shoulders, upper arms, neck, buttocks and thighs.
  • Stiffness in the above mentioned areas. Stiffness is more in the morning after waking up from sleep and after prolonged periods of immobilization like sitting in a car for a long time.
  • Decreased mobility in affected areas like shoulder, buttocks, knees and sometimes elbows. Patients commonly complain of difficulty in raising their arms overhead.

Who is at risk

  • Older people aged more than 60 years
  • Women
  • Caucasians
  • People suffering from Temporal arthritis which manifests as headaches, jaw pain, visual disturbances. 50% of people with temporal arthritis are known to have PMR.

Causes

  • Genetic factors: PMR is seen to occur in individuals with HLA DR4 (i.e. Human Leucocyte Antigen of type DR4) in their blood cells.
  • Environmental factors: In genetically susceptible individuals, a viral infection or a cancer normally acts as a trigger and causes an attack of PMR.

Everything you need to know about the Bone and Joint System

Complications

PMR causes limitations in physical activity which can affect social life and general well being of the patients.

Laboratory Examination

  • Blood tests that show raised markers of inflammation like ESR (Erythrocyte sedimentation rate) and CRP (C reactive protein)
  • Ultrasound
  • MRI
  • Temporal artery biopsy to screen for temporal arthritis: as PMR has a strong association with temporal arthritis and they commonly occur in the same patient

Treatment

  • Corticosteroids: Steroids have strong anti-inflammatory properties which make them the most widely used drugs for PMR. Usually a low dose of Prednisolone is prescribed and it is tapered off over a period of one year or so. In severe cases high doses of steroids need to be taken for prolonged periods. Excess use of steroid can cause adverse effects like acne, easy bruising, weight gain, osteoporosis, peptic ulcer diseases, etc.
  • NSAIDs: Non-Steroidal Anti-inflammatory drugs like Ibuprofen are used to relieve pain and swelling in mild cases.
  • Methotrexate: This drug is an immuno-modulator and is used along with steroids in the treatment of PMR.
  • Physiotherapy: Effective and cornerstone in management of severe cases where there is limitation of activity due to PMR.
  • Healthy diet consisting of leafy vegetables, milk.

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