Polymyalgia Rheumatica is a poorly understood condition characterised by stiffness affecting the shoulders and hips/pelvic region. The disease almost exclusively affects older individuals, generally over the age of 60, being rare below the age of 55. The stiffness is most marked in the mornings and commonly persists for more than 30 minutes.
Patients generally describe that activity is helpful in managing these symptoms and that rest worsens the problem, especially during the night. The onset of these symptoms may be sudden or gradually increase over time, without any obvious cause.
An important point for those affected is that about 15% of patients with Polymyalgia Rheumatica will also have or develop the disease termed Giant Cell Arteritis.
Making the diagnosis can be difficult given that there is no specific diagnostic test. Often the patients are thought to have dysfunction of the rotator cuff muscles in the shoulder or of the gluteal muscles at the hips. Other conditions that are often considered include fibromyalgia, myalgia, and even Parkinson’s disease.
Blood tests that reflect inflammation are generally elevated in those affected. The most commonly measured inflammation markers are Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). These markers however are elevated in any condition that causes inflammation, such as infection and even some types of cancer. Therefore, Polymyalgia Rheumatica is usually only diagnosed when these other causes have been excluded.
When the diagnosis is made, based upon the clinical presentation as described above in the context of raised inflammatory markers, Prednisone is usually prescribed. Polymyalgia Rheumatica is very sensitive to the effect of Prednisone, which is given as an oral therapy, although on occasion a second anti-rheumatic medication may be needed.
Treatment is often continued for some time to minimise the chance of a flare, which becomes uncommon 2-3 years after the onset of the disease.
