Polymyalgia rheumatica (PMR) is a condition that causes inflammation, mainly affecting the muscles and joints around the neck, shoulders, and hips. It usually strikes people over the age of 50 and leads to pain and stiffness that can make everyday movements difficult. The name itself gives a clue: “poly” means many, “myalgia” means muscle pain, and “rheumatica” relates to inflammation affecting the musculoskeletal system.
At its core, PMR is an inflammatory disorder, meaning the body’s immune system mistakenly causes inflammation in the tissues around certain joints and muscles. This inflammation is not in the joints themselves but in the areas surrounding them, such as the bursae (small fluid-filled sacs that cushion joints) and the tendons. This leads to the characteristic symptoms of aching and stiffness, especially in the morning or after periods of inactivity.
The most common areas affected are the shoulders and hips, but the neck and upper arms can also be involved. People with PMR often wake up feeling very stiff and sore, and it can take a long time to loosen up. This stiffness is usually worse in the morning and can last for an hour or more. Because the pain and stiffness are symmetrical, meaning they affect both sides of the body equally, it can be quite disabling, making simple tasks like getting dressed, combing hair, or standing up from a chair challenging.
The exact cause of PMR is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Some researchers think infections might trigger the immune system to react abnormally in susceptible individuals. The inflammation in PMR is linked to elevated levels of certain markers in the blood, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), which indicate active inflammation.
PMR is closely related to another condition called giant cell arteritis (GCA), which involves inflammation of the blood vessels, particularly the arteries in the head and neck. About 10-20% of people with PMR may develop GCA, which can cause headaches, vision problems, and even serious complications if untreated. Because of this connection, doctors carefully monitor patients with PMR for any signs of GCA.
The impact of PMR on joints is indirect but significant. Unlike arthritis, where the joint itself is inflamed and damaged, PMR causes inflammation in the tissues around the joints. This leads to pain and stiffness but usually does not cause joint deformities or permanent damage. However, the discomfort and limited movement can severely affect quality of life, especially in older adults who may already have other health issues.
Diagnosis of PMR is based on clinical symptoms, blood tests showing inflammation, and ruling out other conditions that can cause similar symptoms, such as rheumatoid arthritis or fibromyalgia. Imaging tests like ultrasound can sometimes show inflammation in the bursae around the shoulders and hips, supporting the diagnosis.
Treatment primarily involves corticosteroids, which are powerful anti-inflammatory medications. Even low doses of steroids can dramatically reduce symptoms, often within days. The treatment usually starts with a moderate dose that is gradually tapered down over months to years, depending on the patient’s response. Because long-term steroid use can have side effects, doctors carefully balance the benefits and risks, monitoring patients closely.
In addition to medication, physical therapy and gentle exercise are important to maintain joint mobility and muscle strength. Patients are encouraged to stay active within their limits to prevent stiffness from worsening.
Living with PMR means managing a chronic condition that can flare up and improve over time. While it can be frustrating and painful, most people respond well to treatment and regain much of their function. Awareness of the symptoms and early treatment are key to minimizing the impact on daily life.
In summary, polymyalgia rheumatica is an inflammatory condition affecting the muscles and tissues around the joints, causing pain and stiffness mainly in the shoulders an