Polymyalgia Rheumatica

Polymyalgia Rheumatica is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck; primarily impacts the elderly, associated with morning stiffness and elevated markers of inflammation
  • 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.
  • Average age of onset ~70 years

Pediatric Considerations
Rare in patients <50 years of age. The peak incidence of PMR is between ages 70 and 80 years (1).

Epidemiology

Incidence
  • Incidence increases after age 50 years. Incidence of PMR and giant cell arteritis (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

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

Etiology and Pathophysiology

  • 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

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

Risk Factors

  • Age >50 years
  • Presence of GCA

Commonly Associated Conditions

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

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