Relatively common clinical syndrome associated with ‘aching’ in the elderly – PMR is self limiting. Affects 1/200-1000 over the age of 50 (extremely rare <50yrs). F>M. Closely associated with temporal/giant cell arteritis where they are both possibly on the same continuum.
Characterised by severe pain/aching and stiffness in proximal muscle groups (shoulders and hips). Scintigraphy and thermography show involvement of hip and shoulder joint suggests low-grade synovitis.
Aetiology:
Unknown. Strong genetic predisposition (HLA-DR4), but no immune abnormalities have been detected yet.
Clinical features:
More common in elderly Caucasian woman. Onset may be acute or subacute/insidious – initial diagnosis may take several months. Prolonged morning stiffness is a cardinal feature.
Severe pain/disability and stiffness in neck, pectoral and pelvic girdles (symmetrical and bilateral) – usually insidious in onset; morning stiffness; stiffness after inactivity; poorly localised tenderness over joints (especially hips and shoulders); pain at night – may awaken patient; muscle strength is unaffected; malaise; fever; mild depression; fatigue; weight loss; raised alkaline phosphatase and ESR.
Up to 50% may have another diagnosed rheumatological condition PMR may go unrecognised or undiagnosed.
Diagnosis is based on history and clinical examination (laboratory tests will rule out other causes of symptoms).
Differential Diagnosis:
Early rheumatoid arthritis, shoulder disorder; osteoarthritis, inflammatory muscle disorder, hypothyroidism malignancy
Diagnostic criteria:
Bilateral shoulder or hip pain or stiffness; onset of illness < 2 weeks; elevated ESR; morning stiffness; 65+ years of age; depression and/or weight loss; exclusion of other causes.
Treatment:
Reassurance and education.
Usually follows a benign course most complete resolution within 2 years, but some develop giant cell arteritis (could be up to 30%). ESR can be used to monitor progress and response to treatment.
NSAID’s in first 4 weeks – only effective in up to 20%
Low dose prednisone is usual drug of choice – immediate and dramatic response to small dose is often considered to be diagnostic (often only effective treatment)
Physiotherapy – especially range of motion exercises; strengthening weakened muscles; management of unsteady gait.
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