Musculoskeletal

Polymyalgia Rheumatica

An inflammatory syndrome in adults over 50 causing new bilateral shoulder or pelvic-girdle pain and prolonged stiffness, diagnosed by clinical pattern and exclusion of mimics, with urgent screening for associated giant cell arteritis.

Definition

Polymyalgia rheumatica is an inflammatory syndrome in adults over 50 causing bilateral shoulder and/or pelvic-girdle pain and prolonged morning stiffness, usually with raised inflammatory markers and rapid improvement after appropriate glucocorticoid treatment. It is closely associated with giant cell arteritis.

First principles

PMR is an inflammatory syndrome diagnosed by pattern and exclusion

Polymyalgia rheumatica causes new proximal pain and stiffness, usually around the shoulders and hips, with an acute-phase response and functional limitation. There is no single confirmatory test: age, symptom pattern, examination, inflammatory markers, exclusion of mimics and response to treatment are interpreted together.

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