Continuing Medical Education: Polymyalgia Rheumatica.
Edited By: Gregory C. Gardner, M.D.
Last updated Friday, January 07, 2005
Clinical featuresWhat are the clinical featured of polymyalgia rheumatica? The typical symptoms of PMR include profound AM stiffness so much so that patients have to roll themselves out of the bed.
There is night pain and stiffness and gelling with inactivity. Most
of the symptoms occur in a proximal distribution. Up to 20% of patients
felt to have typical PMR have synovitis of other joints especially the
knee. There are probable variants of PMR that look more like rheumatoid
arthritis. Systemic symptoms also occur and include anorexia, weight
loss, fever, and fatigue. The disease often begins acutely with the
patient able to remember the day or week the symptoms began.
Laboratory features according to Chuang et al include (5):
| Abnormality | Percent |
| Elevated ESR | 99 |
| Mild Anemia | 47 |
| Elevated AST | 23 |
| Hypoalbuminemia | 19 |
| Elevated Alkaline Phos | 10 |
| Elevated Rheum Factor | 0 |
The natural history of PMR has been documented by several report of
the disease in the precorticosteroid era notably Gordon (8). He
described the course of PMR in 8 patients and noted 2 phases. The first
phase consisted of intense stiffness that usually peaked early in the
illness and would partially resolve. The second phase was one of
relatively mild symptom requiring little medication and this would
completely resolve in an average of 2 years. Most authors report that
the mean length of PMR is around 2 years although it appears that there
is a large group that is off corticosteroids by 2 years and a smaller
group that need therapy for a more prolonged period.
Clinically pure PMR (i.e. no symtoms of TA) will occasionally be
complicated by the development of TA. The numbers indicate about 10% of
those presenting initially with only PMR will develop TA (5). The
converse is not true as upwards of 50% of people with TA will have
coexisting PMR. Patients with clinically pure PMR may have a positive
temporal artery biopsy for arteritis but several studies addressing the
issue have indicated that this is not predictive for progression to TA. Surgery for arthritis at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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