Clinical features

Symptoms may begin suddenly or sometimes may accompany constitutional symptoms such as malaise, anorexia, low-grade fever, weight loss, depression and night sweats (although in some onset can be more insidious) (1).

Classical feature of PMR is the pain and stiffness affecting the shoulder girdle, hip girdle, and neck muscles (1).

• most commonly seen those in their 70s (rarely below age 50)
• patients are unable to “turn over in bed or get up from the toilet in the mornings.”
• a pronounced diurnal variation can be seen with symptoms being worst in the morning (stifness may last for an hour)
• ususally bilateral (1,2)
• muscles may be tender
• true weakness does not occur although power and range of movement may be limited by pain and stiffness (3,4)

Additional symptoms which may accompany these core aymptoms include:

• musculoskeletal manifestations
  • swelling and pitting oedema of the hands and feet due to tenosynovitis
  • peripheral arthritis (predominantly seen in wrists and knees) might be seen in up to a third of patients
  • carpal tunnel syndrome (2)
• symptoms of temporal arteritis, for example headaches, may also occur (3)

Reference:

• (1) Mackie SL, Mallen CD. Polymyalgia rheumatica. BMJ. 2013;347:f6937.
• (2) Kermani TA, Warrington KJ.Polymyalgia rheumatica. Lancet. 2013;381(9860):63-72.
• (3) Unwin B, Williams CM. Polymyalgia Rheumatica and Giant Cell Arteritis. Am Fam Physician 2006;74:1547-54, 1557-8
• (4) Dasgupta B, et al. Management guidelines and outcome measures in polymyalgia rheumatica (PMR). Clin Exp Rheumatol 2007;25(Suppl.47):s130-s136