You are in: eMedicine Specialties > Emergency Medicine > RHEUMATOLOGY Polymyalgia RheumaticaArticle Last Updated: Sep 24, 2008AUTHOR AND EDITOR INFORMATIONSection 1 of 10
  Author: Geofrey Nochimson, MD, Consulting Staff, Department of Emergency Medicine, Sentara Careplex Hospital Geofrey Nochimson is a member of the following medical societies: American College of Emergency Physicians Editors: Michael S Beeson, MD, MBA, FACEP, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine; Program Director, Emergency Medicine Residency, Summa Health System; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Gino A Farina, MD, Program Director, Associate Professor of Clinical Emergency Medicine, Department of Emergency Medicine, Long Island Jewish Medical Center, Albert Einstein College of Medicine; John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center; Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System Author and Editor Disclosure Synonyms and related keywords: polymyalgia rheumatica, PMR, giant cell arteritis, rheumatic disease, temporal arteritis, stiffness, aching, pain in the proximal muscle groups, stiffness in the proximal muscle groups, Gel phenomenon, stiffness after prolonged in activity INTRODUCTIONSection 2 of 10
  BackgroundPolymyalgia rheumatica (PMR) is a clinical syndrome characterized by severe aching and stiffness in the neck, shoulder girdle, and pelvic girdle. It is classified as a rheumatic disease, although the etiology is undetermined. PathophysiologyPMR causes severe pain in the proximal muscle groups; however, no evidence of disease is present at muscle biopsy. Muscle strength and electromyographic findings are normal. Some evidence suggests the presence of cell-mediated injury to the elastic lamina in the blood vessels in the affected muscle groups. PMR is closely linked to giant cell arteritis (temporal arteritis), but this is believed to be a separate disease process. FrequencyUnited StatesOne study revealed a prevalence of 1 in 200 people aged 50 years or older. Mortality/MorbidityPMR is not a life-threatening disease, but it does require treatment for 2-4 years. RaceWhites are affected more than other ethnic groups. SexFemales are affected twice as often as males. AgePMR usually affects people older than 50 years. CLINICALSection 3 of 10
HistoryThe patient's history may include the following features:
PhysicalThe signs and symptoms of PMR are nonspecific, and objective findings on physical examination often are lacking. If present, findings may include the following:
CausesThe etiology is unknown; however, risk factors include the following:
DIFFERENTIALSSection 4 of 10
Arthritis, Rheumatoid Depression and Suicide Hypothyroidism and Myxedema Coma Polymyositis Systemic Lupus Erythematosus Temporal Arteritis
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| Drug Name | Prednisone (Deltasone, Orasone, Sterapred) |
|---|---|
| Description | Useful in the treatment of inflammatory and allergic reactions. By reversing increased capillary permeability and suppressing PMN activity, it may decrease inflammation. PMR is rapidly responsive to low doses of prednisone. Patients may require treatment for several months to several years. |
| Adult Dose | 5-60 mg/d PO qd or divided bid/qid; taper over 2 wk as symptoms resolve |
| Pediatric Dose | 4-5 mg/m2/d or 1-2 mg/kg PO qd; taper over 2 wk as symptoms resolve |
| Contraindications | Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections; GI disease |
| Interactions | Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics |
| Pregnancy | B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals |
| Precautions | Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use |
Complications of polymyalgia rheumatica may include the following:
Polymyalgia Rheumatica excerpt
Article Last Updated: Sep 24, 2008
