Polymyalgia rheumatica: Clinical features and management

Polymyalgia rheumatica is a common chronic condition mainly seen in older patients that is characterized by pain and stiffness in proximal muscle regions and an increased ESR. Polymyalgia rheumatica is closely related to GCA and is often present in patients with GCA. Polymyalgia rheumatica and GCA are pathogenetically similar and likely represent different manifestations of the same underlying process. Polymyalgia rheumatica typically responds promptly to treatment with low doses of corticosteroids. Temporal artery biopsy is not necessary in most patients with PMR but should be obtained if any symptoms or signs of GCA are present. Finding arteritis on a temporal artery biopsy obligates treatment with higher doses of corticosteroids to prevent complications of GCA. Although other agents have been used to try to allow lower corticosteroid doses and mitigate against potential steroid-induced side effects, no other medication has been shown clearly to be effective in this regard. Patients with PMR require long-term follow-up for possible late complications of the disease or its treatment.