Polymyalgia Rheumatica

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Original Editors - Nicki Spencer from Bellarmine University's Pathophysiology of Complex Patient Problems project.

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Definition/Description

     Polymyalgia rheumatica (PMR) is a rheumatic inflammatory disorder that has no known cause. (DD book)

Prevalence

     In persons over the age of 50, PMR has a prevalence of approximately 700 per 100,00. (JRSM)

Characteristics/Clinical Presentation

     The onset of PMR is very sudden. Individuals can usually remember the exact time and day that they began experiencing symptoms. Individuals often wake up one morning with extreme stiffness and soreness for no apparent reason. (Path book)

     This disorder generally manifests itself in the muscles of the neck, shoulder girdle, and pelvic girdle. The pain and stiffness is often symmetric and bilateral. (Path book) Other signs and symptoms that can be seen include stiffness after rising in the morning or after resting, weakness, fatigue, malaise, low-grade fever, sweats, headache, weight loss, depression, and vision changes. (DD book)

     Three primary risk factors that are associated with PMR are age, female gender, and race. This disease rarely occurs in individuals younger than 50 and most occur in individuals over the age of 70. Women are affected twice as much as men. PMR is more commonly seen in Caucasian women than women of any other ethnicity. (Path book)

Associated Co-morbidities

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Medications

     Corticosteroids If PMR is suspected to be the probable diagnosis for a patient, then a trial of low-dose corticosteroids is given. The response to corticosteroids is usually dramatic, and patients may report relief in symptoms after one dose. If symptoms are not better within 2-3 weeks of beginning the corticosteroid treatment, it is unlikely that the individual actually has PMR and more testing should be performed to find an appropriate diagnosis. (rheumatology.org)

     If the patient has a favorable response to corticosteroids, they will continue to take a maintenance dosage for approximately 6 months to 2 years. (Path book) This maintenance dosage can help control the pain and stiffness associated with PMR. Over that time period, the dosage is gradually decreased until it is no longer needed. Complete clinical remission may take up to 5 years to occur. (Path book)

Diagnostic Tests/Lab Tests/Lab Values

     PMR is a diagnosis of exclusion. (JRSM) There are no definitive diagnostic tests to identify PMR. (Path book) Physicians will typically perform a physical exam, order blood tests, and perform imaging studies to determine if the patient’s symptoms are due to some other disorder. (Mayo clinic) Some clinicians use an erythrocyte sedimentation rate (ESR) of higher than 30 or 40 mm/hr as diagnostic criteria; however, there have been reports of individuals diagnosed with PMR having an ESR of normal or only slightly higher than normal so this may not be an appropriate criteria. (Path book)

Etiology/Causes

     There is no clear cause for PMR; however, research has begun to suggest that it may occur due to a combination of environmental and genetic factors. (Mayo clinic)

     Certain characteristics of PMR suggest that an environmental cause could be an infectious disease. It has a very sudden onset and new cases occur in cycles, which could indicate an infection as the source. (Mayo clinic)

     The gene(s) that could be responsible for PMR has not been identified. Inheritance of the disorder has been suggested due to findings in some genetic studies and a pattern seen in family histories. (Mayo clinic)

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

• Polymyalgia rheumatic and exercise: a single case report on one woman
• Isolated lower extremity vasculitis in a patient with polymyalgia rheumatica

Resources

• American College of Rheumatology- http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/polymyalgiarheumatica.asp
• National Library of Medicine - http://www.nlm.nih.gov/medlineplus/polymyalgiarheumatica.html
• National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse - http://www.niams.nih.gov/Health_Info/Polymyalgia/default.asp
• Arthritis Foundation - http://www.arthritis.org/conditions/diseasecenter/pmr.asp

Recent Related Research (from Pubmed)

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References

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