Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Polymyalgia rheumatica
What it is
Polymyalgia rheumatica is an inflammatory condition that causes pain and stiffness in the shoulders, the pelvic girdle and the neck. There is a strong association with giant cell arteritis and the two conditions often occur together; it overlaps with temporal arteritis, histology shows vasculitis with giant cells that characteristically skips certain sections of the affected artery whilst damaging others, and the arteries of the muscle bed are the ones most affected.
Causes and risk
The cause is not fully understood and there are no relevant antibodies. It is more common in older white patients. The age given differs: over 50 in one list and over 60 in another.
How it presents
The onset is relatively rapid, over days to weeks and usually within a month, and symptoms should be present for two weeks before the diagnosis is considered. The core symptoms are pain and stiffness of the shoulders, potentially radiating to the upper arm and elbow, of the pelvic girdle around the hips, potentially radiating to the thighs, and of the neck. The findings set out for it are age over 50, bilateral pain and morning stiffness of more than 1 month, and involvement of two of the following: neck or torso, shoulders or proximal arms, proximal thigh or hip, and constitutional features such as fever, malaise and weight loss. The stiffness is worse in the morning, worse after rest or inactivity, interferes with sleep, takes at least 45 minutes to ease in the morning, and improves somewhat with activity. It is aching and stiffness of proximal limb muscles, not weakness. Associated features are systemic symptoms such as weight loss, fatigue and low-grade fever, muscle tenderness, carpal tunnel syndrome and peripheral oedema, along with mild polyarthralgia, lethargy, depression, anorexia and night sweats. On examination the active ROM of the shoulders, neck and hips is decreased.