What is PMR?

PMR is an infl ammatory disorder that causes aching and stiff ness starting in the neck, shoulders, and hips. It aff ects mainly adults in their 60s and 70s and is rarely diagnosed before age 50. Th e disorder is twice as likely to occur in women and is more common in whites than in blacks.
Among Caucasians, PMR is about as common as rheumatoid arthritis, aff ecting nearly 1% of people over age 50. Th e infl ammation that causes PMR generally occurs in the muscles and soft tissues of the shoulders and hips and in the bursa (small fl uid-fi lled sacs that cushion tendons where they attach to bone) in those areas. We don’t know exactly what triggers the condition.
Scientists suspect it’s a combination of factors, including immune system abnormalities, genes, and aging. Th e aching and stiff ness usually last 30 minutes or more and are at their worst fi rst
thing in the morning (or aft er a period of inactivity). Th e discomfort oft en causes nighttime awakenings, and turning over in bed may be diffi cult. Some people with PMR also have fl ulike symptoms, including low-grade fever, fatigue, and weight loss.
There is no defi nitive way to diagnose PMR. To make the diagnosis, a clinician will review a woman’s health history and perform a physical exam. Th e symptoms of PMR are common, so it’s a challenge to exclude other causes, such as rheumatoid arthritis, fi bromyalgia, muscle conditions, tendonitis, bursitis, infection, thyroid problems, or cancer. Doing so may require several lab tests and x-rays.
A person with PMR usually feels stiff and achy in at least two of three areas: the neck, the shoulders or upper arms, and the hips or upper thighs. Joints generally aren’t swollen or red, as they are in rheumatoid arthritis, but occasionally, a joint in the hand, ankle, or foot will be swollen. X-rays are usually normal.
Th e most characteristic laboratory fi nding in PMR is an elevated erythrocyte sedimentation rate (ESR), sometimes called a “sed rate” (see “What’s a sedimentation rate?”). This blood test measures the level of infl ammation in the body. When other conditions that cause infl ammation are ruled out, a high ESR number (50 or greater) in a person over age 50 with PMR symptoms is strong evidence for the disease.
PMR oft en disappears on its own within a few years, but not without taking a heavy toll on a woman’s quality of life. Non-steroidal anti-infl ammatory drugs such as aspirin and ibuprofen can help with mild symptoms. But PMR generally responds best to very low doses of corticosteroid medications (“steroids,” for short), such as prednisone. In fact, symptoms improve almost overnight. Th is rapid response helps confi rm a PMR diagnosis: If low doses of steroids don’t help, PMR is probably not the cause. Doses can be further reduced as symptoms improve, but relapse is likely if they’re stopped too soon. Most people need to continue taking a very low dose for six months to two years.
PMR is not dangerous in itself, but it oft en occurs in people who have a more serious infl ammatory condition called giant cell arteritis (GCA). In this condition, the lining of arteries in the head, neck, and arms becomes infl amed, narrowing the arteries and causing symptoms such as headache (especially around the temples, which may be tender to the touch), scalp tenderness, and pain or weakness in the jaw. Th e most common dangerous complication of GCA is blindness, which almost never occurs if the condition is recognized and treated promptly. Untreated, GCA can also lead to stroke or an aortic aneurysm—a bulge in the large artery that runs between the chest and abdomen. The only way to defi nitively diagnose GCA is to take a biopsy of an artery in the temple and examine it under a microscope for evidence of the condition.
PMR occurs in about 50% of people who have GCA, and 15% of people with PMR will also develop GCA. It’s not clear how or why this relationship exists. To reduce the small but defi nite risk of permanent blindness from GCA, patients with PMR should take a high dose of prednisone once early in the course of symptoms.
Although long-term, high-dose steroid treatment has many side eff ects, the low doses used in treating PMR— and the high doses used for a relatively short time in people with GCA—rarely cause problems. However, women should be aware that taking even low doses of steroids for several years slightly increases their risk for steroid-related conditions, including osteoporosis, glaucoma, cataracts, high blood pressure, weight gain, jumpiness, and insomnia.
When you take steroids, it’s important for your clinician to properly monitor the eff ects and taper the dose.

Harvard Women's Health Watch, Sep2006