Polymyalgia rheumatica (PMR)

Health and Nutrition > Diseases > P Written by Dr Badal Pal, consultant rheumatologist

What is PMR?

Polymyalgia (poly = many; myalgia = aching muscles) rheumatica (PMR) is an inflammatory rheumatic condition. It affects around 4 per 1000 people over the age of 50 but is rare under this age. The peak age PMR occurs tends to be between 40 and 59. Symptoms can start abruptly, or can come on over a week or two.

Both men and women are equally affected but women slightly more than men. Although it is common in Caucasians and rare in Asians and Afro-Caribbeans.

What causes PMR?

Some people notice a flu-like illness just prior to the onset of symptoms - occasionally, this turns out to be caused by a parvovirus infection - but in most cases PMR is spontaneous and has no known cause.

What are the main symptoms?

PMR causes sudden/abrupt pain and morning stiffness, mainly in and around the shoulders and thighs (it may also affect the neck and torso). Often, patients cannot get out of bed without help and notice difficulty climbing stairs.

Prolonged rest or inactivity may increase the stiffness and activities such as driving become more difficult.

Other common complaints include feeling generally unwell and tired. Occasionally, a slight fever accompanies the condition. Some patients notice a loss of appetite and weight.

In the most severe form of PMR, painful inflammation occurs in the arteries in the head, particularly around the temple area: this is called temporal arteritis.

Fortunately, no organ systems are usually affected, eg no liver, kidney or lung damage occurs in typical PMR.

How is PMR investigated and confirmed?

Commonly, doctors perform two blood tests to determine whether a patient has PMR: the erythrocyte sedimentation rate (ESR) and/or the C-reactive protein (CRP) test.

Both of these blood tests give a broad indication that there is some inflammation going on in the body. Many conditions cause the ESR and CRP to change, so a number of other tests may have to be performed to exclude those that can be mistaken for PMR.

Conditions that can be mistaken for PMR