Polymyalgia Rheumatica (PMR)

What is PMR?

Polymyalgia rheumatica (PMR) is a medical condition characterized by pain, swelling and restricted movement in multiple joints especially the neck, shoulder and hip joints. The exact underlying cause of polymyalgia rheumatica is not known, however, patients with temporal arteritis, a disease characterized by inflammatory changes in the blood vessels also suffer from polymyalgia rheumatic. Usually people above 65 years of age are most commonly affected and it is rare in people less than 50 years of age. The main treatment of polymyalgia rheumatica is dependent upon oral intake of steroids.

PMR Symptoms

Symptoms of polymyalgia rheumatica usually affect both the sides of the body however one sided involvement may also occur. Common symptoms include pain in the shoulder joint (most commonly noticeable among initial symptoms), pain the neck, upper part of the arm, thigh, buttock, hips and thigh. Other than pain polymyalgia rheumatica also leads to stiffness of the affected joints especially after prolong period of inactivity like immediately after waking up or after prolonged sitting during prolonged flights or car ride. The affected joints become stiff with limited movement. Involvement of other joints like the wrist and the knee are uncommon.

Other than joint involvement certain other general symptoms may also occur, these are low grade fever, increased tiredness, generalized body ache, drastic unintended weight loss, poor appetite and depression. In advanced cases of polymyalgia rheumatica joint involvement can become so severe that often it becomes almost impossible for the affected person even to carry out simple daily activities like getting out of car, standing from sitting posture, combing hair, buttoning dresses, putting on dresses, brushing teeth etc. This type of interruption in the daily activities of the affected person may lead to number of complications like deterioration of physical, mental health, poor social interaction and lack of sleep.

Causes of PMR

The exact cause is not known however according to some experts interplay of two important factors is the most important cause behind polymyalgia rheumatica. These factors are inheritance of certain genetic factors which increases the risk of suffering from the disease and exposure to certain environmental factors as supported by the fact that attacks of polymyalgia rheumatica occur especially during specific season.

It is also thought that polymyalgia rheumatica and giant cell arteritis are same disease with different manifestation. About 30% of patients of polymyalgia rheumatica suffer from giant cell arteritis and about 50% of the patients of giant cell arteritis suffer from polymyalgia rheumatica.

Common risk factors include age of the patient, as the disease is more common in aged person, being females as they have about two and half times increased risk in comparison to males and people with European origin (people of Middle-east and Asian descent are at the lowest risk)

Treatment of PMR

Usually it takes almost a year maximum control of symptoms. Low dose oral steroids namely prednisolone is the drug of choice for polymyalgia rheumatica. Calcium and vitamin D supplementation, other drugs like methotrexate and anti-TNF drugs are also prescribed to control underlying inflammatory changes of the joints. Regular specific exercise helps in gaining strength in the joints and enabling the person to carry out normal daily life.

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