Polymyalgia Rheumatica

BASICS

An inflammatory clinical syndrome characterized by pain and morning stiffness of the shoulder, hip girdles, and neck; primarily impacts patients aged >50 years; associated with morning stiffness and elevated markers of inflammation
Can be associated with giant cell arteritis (GCA)
System(s) affected: musculoskeletal; hematologic/lymphatic/immunologic
Synonym(s): senile rheumatic disease; polymyalgia rheumatica (PMR) syndrome; pseudo-polyarthrite rhizomélique

Geriatric Considerations
Incidence increases with age (age >50 years).Pediatric Considerations
Rare in patients <50 years of age (1)

Incidence increases after age 50 years. Incidence of PMR and GCA in the United States is 50 and 18 per 100,000 people, respectively.
Predominant sex: female > male (2 to 3:1)
Most common in Caucasians, especially those of northern European ancestry and in Scandinavian countries
Peak incidence occurs between ages 70 and 80.

Prevalence in those >50 years old: 700/100,000

Unknown; symptoms relate to enhanced immune system and periarticular inflammatory activity.
Pathogenesis
- Polygenic; involves multiple environmental and genetic factors
- Significant association between histologic evidence of GCA and parvovirus B19 DNA in temporal artery specimen

Associated with human leukocyte antigen determinants (HLA-DRB1*04 and DRB1*01 alleles)

Concurrent GCA (temporal arteritis) in ~15–30% of patients; more commonly in females than males

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