by Hope Starkman, MD

Polymyalgia rheumatica(PMR) is a condition that generally has the potential to affect individuals over the age of fifty. PMR can occur abruptly or can be insidious (develop more slowly over time) Many people wake up one morning with pain and stiffness of their shoulders, arms, neck, hips and upper legs. Like in most other rheumatic diseases, stiffness and pain seems to be worse in the morning or after periods of extended rest (The typical morning gel). The typical person is fine one day and awakens the next with difficulty raising their arms to put their clothing on due to pain and stiffness and also problems standing from seated position due to pain and stiffness in their hip and thigh area. Getting out of a bed, off the toilet, out of a seat, coming hair, self care taking abilities become compromised. Some people also develop arthritis, pain and swelling of the hands and wrists. These patients may ultimately progress to Rheumatoid Arthritis. Weight loss, fatigue, decreased appetite and fever may accompany PMR.

Laboratory findings often consist of an elevation in the Erythrocyte Sedimentation Rate (ESR or Sed rate). Other abnormal labs identified in patients with PMR include an elevated C reactive protein (CRP), increased alkaline phosphatase (normal muscle enzymes and transaminases – SGOT and SGPT)An anemia of chronic inflammation with a hemoglobin of about 10.0 is common in PMR. This is not true of a condition called fibromyalgia in which patients have similar pain but completely normal lab tests. Muscle biopsies are normal in PMR as opposed to in polymyositis.

Twenty to 30 percent of patients with PMR may develop another condition called Temporal Arteritis which presents with headaches, chewing related jaw pain, scalp tenderness and vision changes and if untreated can result in blindness and or stroke.

The treatment of PMR involves the use of steroids like Prednisone or Medroxyprednisolone. Usually abou0t 15 to 20 mg per day tapered over 6 months to a year. The most common mistake in treating PMR is to taper the steroids too quickly. This results often in another flare. Some patients may need to stay on prednisone or similar steroids for a longer period of time especially those that develop Rheumatoid arthritis. Patients with Temporal Arteritis need to be on 60 to 100 mg of Prednisone per day. There is no hard and fast rule for tapering steroids because ability to taper steroids varies from person to person.

Very rarely milder forms of PMR can be treated with nonsteroidal antiinflammatories and sometimes patients will require treatment with medications in addition to steroids like methotrexate. The ESR/Sed rate should be followed uring the course of the steroid taper. Some patients with PMR and even Temporal Arteritis, however never develop an elevated ESR/Sed Rate. I have personally treated a gentleman who developed bilateral blindness due to Temporal arteritis prior to his initial visit with me who never had an increased Sed rate. The clinical picture of the patient is far more important than the labs tests and numbers which should serve only as guidelines.

Consideration should also be given to preventative measures ie addressing adverse effects of steroids and preventing conditions such as osteoporosis form developing.

In general, the prognosis of PMR is excellent and most patients are able to fully taper off of steroids.