Polymyalgia Rheumatica
Christian Dejaco, Eric L. Matteson
Abstract
Polymyalgia rheumatica is an inflammatory condition that affects persons older than 50 years of age and is characterized by pain in both shoulders with or without hip or neck pain (or both) and with pronounced morning stiffness. The condition is typically diagnosed on the basis of these hallmark symptoms along with elevated inflammation markers (erythrocyte sedimentation rate and C-reactive protein level) and the ruling out of other conditions including giant-cell arteritis. Glucocorticoids are the primary treatment, which provide rapid symptom relief. The initial dose, usually 12.5 to 25 mg of prednisone equivalent daily, is gradually reduced, ideally over 12 months or less, although the disease course varies and polymyalgia rheumatica may persist for a longer duration. Relapses are common and sometimes warrant the use of interleukin-6 receptor inhibitors or methotrexate to minimize glucocorticoid exposure.