{"id":10,"date":"2026-07-10T13:58:28","date_gmt":"2026-07-10T13:58:28","guid":{"rendered":"https:\/\/neetpgforum.in\/blog\/?p=10"},"modified":"2026-07-10T13:59:29","modified_gmt":"2026-07-10T13:59:29","slug":"polymyalgia-rheumatica","status":"publish","type":"post","link":"https:\/\/neetpgforum.in\/blog\/polymyalgia-rheumatica\/","title":{"rendered":"Polymyalgia Rheumatica"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Polymyalgia rheumatica (PMR)<\/strong> is an inflammatory rheumatic disorder affecting adults <strong>older than 50 years<\/strong>, characterized by <strong>pain and stiffness<\/strong> involving the <strong>shoulder and pelvic girdles<\/strong>, with elevated inflammatory markers and a <strong>dramatic response to low-dose corticosteroids<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">PMR is closely associated with Giant Cell Arteritis (GCA), and the two conditions may occur together.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Etiology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Cause is unknown.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Possible factors:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Genetic predisposition (HLA-DR4)<\/li>\n\n\n\n<li>Environmental triggers<\/li>\n\n\n\n<li>Viral infections (proposed)<\/li>\n\n\n\n<li>Immune-mediated inflammation<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Pathophysiology<\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Inflammation mainly affects:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Synovium<\/li>\n\n\n\n<li>Bursa (especially subacromial and trochanteric bursae)<\/li>\n\n\n\n<li>Tendons<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Unlike inflammatory myopathies:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Muscle fibers are <strong>normal<\/strong><\/li>\n\n\n\n<li>Pain arises from periarticular inflammation rather than muscle destruction.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Major cytokines:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>IL-6 <\/li>\n\n\n\n<li>IL-1 <\/li>\n\n\n\n<li>TNF-\u03b1<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Clinical Features<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">Symptoms<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Pain<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Usually bilateral involving:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Shoulders (most common)<\/li>\n\n\n\n<li>Neck<\/li>\n\n\n\n<li>Upper arms<\/li>\n\n\n\n<li>Hip girdle<\/li>\n\n\n\n<li>Thighs<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Pain is:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aching<\/li>\n\n\n\n<li>Symmetrical<\/li>\n\n\n\n<li>Worse in morning<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Morning stiffness<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Typically:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Lasts <strong>>45 minutes<\/strong><\/li>\n\n\n\n<li>Difficulty:\n<ul class=\"wp-block-list\">\n<li>Getting out of bed<\/li>\n\n\n\n<li>Raising arms<\/li>\n\n\n\n<li>Climbing stairs<\/li>\n\n\n\n<li>Combing hair<\/li>\n\n\n\n<li>Dressing<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Constitutional symptoms<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">May include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Low-grade fever<\/li>\n\n\n\n<li>Malaise<\/li>\n\n\n\n<li>Fatigue<\/li>\n\n\n\n<li>Weight loss<\/li>\n\n\n\n<li>Loss of appetite<\/li>\n\n\n\n<li>Depression<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Association with Giant Cell Arteritis<\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Approximately:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>15\u201320% of PMR patients develop GCA.<\/li>\n\n\n\n<li>Around 40\u201360% of GCA patients have PMR symptoms.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Symptoms suggesting GCA<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>New-onset headache<\/li>\n\n\n\n<li>Jaw claudication<\/li>\n\n\n\n<li>Scalp tenderness<\/li>\n\n\n\n<li>Visual disturbance<\/li>\n\n\n\n<li>Diplopia<\/li>\n\n\n\n<li>Sudden vision loss (medical emergency)<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Investigations<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">Blood tests<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Elevated inflammatory markers<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>ESR \u2191 (often >40 mm\/hr)<\/li>\n\n\n\n<li>CRP \u2191<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">CBC<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">May show:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Normocytic anemia<\/li>\n\n\n\n<li>Thrombocytosis<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Others<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Liver enzymes (ALP) may be mildly elevated.<\/li>\n\n\n\n<li>CK is <strong>normal<\/strong> (helps distinguish from myositis).<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Autoantibodies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Usually negative:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Rheumatoid factor (RF)<\/li>\n\n\n\n<li>Anti-CCP<\/li>\n\n\n\n<li>ANA<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Imaging<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Ultrasound<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">May demonstrate:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Subdeltoid bursitis<\/li>\n\n\n\n<li>Biceps tenosynovitis<\/li>\n\n\n\n<li>Hip synovitis<\/li>\n\n\n\n<li>Trochanteric bursitis<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">MRI<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Useful if diagnosis is uncertain.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">PET-CT<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Can identify associated large-vessel vasculitis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h1 class=\"wp-block-heading\">Diagnostic Criteria (2012 ACR\/EULAR Classification)<\/h1>\n\n\n\n<p class=\"wp-block-paragraph\">Required:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Age \u226550 years<\/li>\n\n\n\n<li>Bilateral shoulder pain<\/li>\n\n\n\n<li>Elevated ESR or CRP<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Additional features include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Morning stiffness >45 minutes<\/li>\n\n\n\n<li>Hip pain or limited range of motion<\/li>\n\n\n\n<li>Negative RF\/anti-CCP<\/li>\n\n\n\n<li>Absence of other joint involvement<\/li>\n\n\n\n<li>Ultrasound findings supportive of PMR<\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Management<\/h1>\n\n\n\n<h2 class=\"wp-block-heading\">First-line treatment<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Prednisolone<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Typical starting dose:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>12.5\u201325 mg orally once daily<\/strong> (commonly <strong>15 mg\/day<\/strong>)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Expected response:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Significant improvement within <strong>24\u201372 hours<\/strong><\/li>\n\n\n\n<li>Lack of improvement should prompt reconsideration of the diagnosis.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Steroid taper<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A common approach:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Maintain initial dose for 2\u20134 weeks after symptom control.<\/li>\n\n\n\n<li>Reduce gradually to 10 mg\/day over several weeks.<\/li>\n\n\n\n<li>Then taper by about 1 mg every 1\u20132 months if stable.<\/li>\n\n\n\n<li>Total treatment duration is often <strong>1\u20132 years<\/strong>, individualized by symptoms and inflammatory markers.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Steroid-sparing therapy<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Consider in recurrent disease or when steroid toxicity is a concern:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Methotrexate<\/li>\n\n\n\n<li>An IL-6 inhibitor such as Sarilumab may be used in selected patients with refractory or relapsing PMR.<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Bone protection<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Because prolonged corticosteroid therapy increases fracture risk:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Calcium supplementation<\/li>\n\n\n\n<li>Vitamin D supplementation<\/li>\n\n\n\n<li>Consider bisphosphonates in patients at moderate or high fracture risk.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Polymyalgia rheumatica (PMR) is an inflammatory rheumatic disorder affecting adults older than 50 years, characterized by pain and stiffness involving the shoulder and pelvic girdles, with elevated inflammatory markers and a dramatic response to low-dose corticosteroids. PMR is closely associated with Giant Cell Arteritis (GCA), and the two conditions may occur together. Etiology Cause is [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[3,4],"class_list":["post-10","post","type-post","status-publish","format-standard","hentry","category-blog","tag-medicine","tag-vasculitis"],"_links":{"self":[{"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/posts\/10","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/comments?post=10"}],"version-history":[{"count":1,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/posts\/10\/revisions"}],"predecessor-version":[{"id":11,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/posts\/10\/revisions\/11"}],"wp:attachment":[{"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/media?parent=10"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/categories?post=10"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neetpgforum.in\/blog\/wp-json\/wp\/v2\/tags?post=10"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}