Polymyalgia rheumatica

Polymyalgia rheumatica is a clinical syndrome characterized by pain and stiffness in the muscles of the shoulder girdle, pelvic girdle, and neck. The disease occurs in people over the age of 50 and women are more often affected. Giant cell arteritis occurs in 10–20% of affected individuals at the same time.

Etiopathogenesis
The etiopathogenesis of the disease is not fully understood. Age (the older the individual is, the higher the risk) and genetic factors play a role. Patients have a large number of IL-6-producing monocytes in their blood.

The clinical picture
The disease usually manifests suddenly. It manifests itself in stiffness and pain in the muscles of the shoulder girdle, pelvic girdle and neck. The pain is most intense in the morning. Pain limits the range of movement. General symptoms include fatigue, subfebrile illness, weight loss, and nausea. Patients may appear severely ill.

Diagnosis
The diagnosis of the disease is usually by exclusion of other etiologies, as no specific test is available.


 * Laboratory findings - increased erythrocyte sedimentation, CRP, IL-6.
 * Imaging methods - if current giant cell arteritis is suspected, PET/CT, for example, is suitable.

Differential diagnosis

 * Rheumatoid arthritis
 * Polymyositis
 * Osteoarthrosis
 * Fibromyalgia

Treatment
The disease is characterized by a good response to glucocorticoid therapy. Doses of 10-20 mg prednisone daily are usually given. We gradually reduce the dose of corticoids after the desired response is achieved. Some patients require prednisone for more than two years.

'''Prevention of osteoporosis should be considered with long-term administration of glucocorticoids. All patients should be prescribed vitamin D, calcium, or bisphosphonates.'''

Related Articles

 * Treatment of inflammatory rheumatic diseases
 * Giant cell arteritis