What is Polymyalgia Rheumatica (PMR) ?
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Polymyalgia Rheumatica (PMR) is an inflammatory condition that many people now believe can be a form of vasculitis. It is recognised to be an autoimmune illness. It causes pain, tenderness and stiffness in the large muscles around the shoulders, hips and back. It generally affects older people and is rare in people under 50. The average age of onset is around 76. Each year about 4 out of every 10,000 people in the UK develop PMR, and about three quarters of these are women. It is categorised as an autoimmune illness. While some people recover after about two years of treatment, more recent estimates put the average length of the condition at about three and a half years. It may be that the majority of people recover after a couple of years or so, but some have a more complex form of the illness that takes longer.
What are the Symptoms?
Symptoms often appear very suddenly, over just a few days, or may develop more slowly. It is easily confused with other conditions, and sometimes passed off as ‘the aches and pains of getting older’. However, people with PMR know the misery of constant discomfort and the fear and anxiety of suddenly not being able to move and get around.
- Stiffness, pain, aching, and tenderness in the muscles around the shoulders, pelvis, and neck, worse first thing in the morning but easing during the day
- Difficulty getting out of bed, reaching and rising
- Inflammation and swelling in other areas, e.g. tendons, hands, feet, and joints
- Night Sweats
- Loss of Appetite
- Weight Loss
How is it diagnosed?
PMR is a bit mysterious. It ‘mimics’ other illnesses and in diagnosis other possibilities, such as rheumatoid arthritis, have to be ruled out first. Your GP will take blood tests to test the ‘inflammatory markers’ in the body. The key tests are ‘ESR’ and ‘CRP’.
What is the Treatment?
Once diagnosed, treatment is with steroids (usually prednisolone) and recovery can be spectacular. The recommended starting dose is 15mg daily, tapering off to a ‘maintenance dose’ of 5-7mg a day. It often takes several months to get down to this. As soon as possible, the doctor will start reducing the dosage to reduce it to zero. In some cases, PMR ‘burns itself out’ after a couple of years. For other people, this can take longer. While reducing steroid use, painkillers such as paracetemol can be helpful. It’s important to remember that everybody is different, and our experiences of PMR and treatment can differ from the ‘textbook’ version.
Are there any Complications?
About 1 in 20 people on treatment for PMR (or 7 out of 20 people with untreated PMR) develop giant cell (or temporal) arteritis, a related condition causing inflammation of arteries (see section on Giant Cell Arteritis).
Consult a doctor urgently if you have PMR and you develop any of the following symptoms:
- Headache or tenderness on one side of your head.
- Jaw pain when chewing.
- Sudden loss of vision.
- Any other sudden visual problem in one eye.
- Weakness, numbness, deafness.
It is very important for everyone with PMR to be aware of the symptoms of Giant Cell Arteritis, as if left untreated it can lead to permanent vision damage.
Polymyalgia Rheumatica - booklet
Arthritis Research UK is a charity that funds high class research as well as educate and inform the general public about different musculoskeletal conditions. They released a booklet on Polymyalgia Rheumatica (PMR) which provides answers to questions about this condition.
To download the booklet please click here.
The following is a link to private rheumatologists in the UK.