Polymyalgia rheumatica

Abstract

Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdles in individuals over 50 years of age along with increased markers of inflammation. Although the above clinical symptoms are very characteristic for the condition, it is considered a diagnosis of exclusion as other autoimmune, as well as infectious, malignant and endocrine disorders can present with similar symptoms. It can co-occur with elderly-onset RA (EORA) or giant cell arteritis (GCA), and these should be explored as alternative diagnoses in every patient. The cornerstone of PMR treatment is low to medium doses of glucocorticosteroids (GC), but while there is typically a swift response to GC treatment, response rate is variable and flare-ups occurs in 50% of patients while tapering down GC doses. Because GC treatment itself is associated with a myriad of deleterious side effects, screening and management of patient comorbidities which may be affected by GC treatment should be carried out on a regular basis during treatment, with novel immunosuppressive agents such as interleukin (IL)-6 blocking agents being developed as GC-sparing agents.