What is pmr medical condition

Often, the dose is 10—15 milligrams per day of prednisone Deltasone, Orasone, etc. If PMR is present, the medicine quickly relieves stiffness. The response to corticosteroids can be dramatic. Sometimes patients are better after only one dose.

Improvement can be slower, though. But, if symptoms do not go away after two or three weeks of treatment, the diagnosis of PMR is not likely, and your doctor will consider other causes of your illness. When your symptoms are under control, your doctor will slowly decrease the dose of corticosteroid medicine. The goal is to find the lowest dose that keeps you comfortable. Some people can stop taking corticosteroids within a year. Others, though, will need a small amount of this medicine for 2—3 years, to keep aching and stiffness under control.

Symptoms can recur. Because the symptoms of PMR are sensitive to even small changes in the dose of corticosteroids, your doctor should direct the gradual decrease of this medicine. Once the stiffness has gone away, you can resume all normal activities, including exercise. Even low doses of corticosteroids can cause side effects.

These include higher blood sugar, weight gain, sleeplessness, osteoporosis bone loss , cataracts, thinning of the skin and bruising. Checking for these problems, including bone density testing, is an important part of follow-up visits with your doctor. Older patients may need medicine to prevent osteoporosis. PMR can occur with a more serious condition, giant cell arteritis. Therefore, small joints inflammation is not reported by a patient whose main complaint is inability to get out of bed.

Further, serious, GCA-associated ischaemic manifestations such as double vision or jaw claudication that are typical prodromal symptoms of vision loss can be unreported by patients seeking medical advice because of much more disturbing manifestations of overlapping PMR.

Paraneoplastic syndromes that can be manifested long before an appearance of symptoms associated with tumour growth may also be misclassified as PMR Differentiation between PMR and seronegative, elderly onset RA affecting proximal joints is actually a common reason for diagnostic uncertainty.

It may also be a case if bilateral painful shoulder syndrome coexists with depression and elevated ESR. Ultrasound examination of the shoulder joints may be helpful in determining the cause of the pain. Diagnosing the sources of inflammatory reaction and mood disorders in the elderly may be demanding, requiring knowledge on geriatrics.

Musculoskeletal symptoms resembling PMR may originate from myopathy due to hypo- or hyperthyroidism, CSs or statins use, amyloidosis; Addison's disease also adynamia suggesting depression and a good response to CSs 49 , Typical PMR age group is associated with a high risk of cancer.

Manifestations of PMR may also resemble paraneoplastic syndromes. However, PMR frequently starts suddenly and manifests more dynamically. Spontaneous remission, which can occur in PMR, is unusual for cancer. Attempts should be made to minimize this period by differential diagnostics and careful observation of atypical PMR cases Some of the PMR symptoms fever, night sweats and joint pain may suggest systemic lupus erythematosus or other autoimmune diseases and infectious diseases, including endocarditis or tuberculosis.

Focus on musculoskeletal pain can mask the endogenous or reactive depression being the real cause of deterioration of patient's state. Due to PMR and GCA overlap, physical examination of PMR patients should encompass temporal arteries for tenderness, loss of pulsation and large arteries analogically to Takayasu arteritis upper and lower limbs intermittent claudication, differences in blood pressure between both limbs, presence of vascular bruits.

Treatment-resistant PMR indicates a special need for imaging of large arteries for overlapping vasculitis. It may include ultrasound examination of temporal and large axillary, sub-clavian, common carotid arteries by a specialist experienced in differentiating vascular wall inflammation from arteriosclerosis, as well as assessment of the aorta and its branches with contrasted computed tomography CT , magnetic resonance imaging MRI or positron emission tomography PET with CT 52 , Lack of GCA manifestations at the time of PMR diagnosis should not stop the awareness of developing vasculitis during follow up.

PMR patients should be educated to immediately seek medical advice in case of vision disturbance double vision, transient ischaemic attacks , jaw claudication or scalp tenderness. Rapid and spectacular improvement shortly after CSs introduction enables concluding on a cause based on an observed response to the treatment. Therefore, PMR patients are much pleased shortly after treatment initiation and grateful to their doctors Diagnosis ex juvantibus was included in Jones and Hazleman's criteria New, PMR classification criteria do not include a good response to CSs in the diagnostic process It raised some discussion as this criterion is widely used in a daily practice It was argued that treatment response was non-specific and difficult to define feature.

Indeed, elderly onset RA or other inflammatory conditions also respond well to CSs. However, this response would be weak in OA and transient if applied in infection or neoplasm. In these cases review of the initial PMR diagnosis is needed. It is not a mistake to reassess the initial diagnosis and change it accordingly.

About 10 per cent of patients initially diagnosed with PMR are later reclassified as having elderly onset RA For that purpose, careful monitoring of patients is needed. PMR patients require regular medical check-ups. Diagnosing ex juvantibus may also be made eagerly because it does not require an effort of time-consuming and expensive procedures.

Based on our own experience, PMR is easy to overdiagnose. Establishing rational PMR diagnosis illustrates a challenge to resist fashion and wishful thinking in medicine.

Adherence to the PMR classification criteria could be beneficial in preventing overdiagnosis because these do not include response to therapy. At least as long as there are no better disease markers. Lack of specific biomarkers of PMR is problematic and research is needed. Up to now, the diagnosis remains clinical. There are many clinical subtleties to be considered. However, differential diagnosis encompasses diseases with bad prognosis; therefore, PMR overdiagnosis can be detrimental.

Conflicts of Interest: None. National Center for Biotechnology Information , U. Indian J Med Res. Marcin Milchert and Marek Brzosko. Author information Article notes Copyright and License information Disclaimer. Reprint requests: Dr.

Received Feb This article has been cited by other articles in PMC. Abstract Polymyalgia rheumatica PMR is a unique disease of elderly people, traditionally diagnosed based on a clinical picture. Key words: Classification criteria, corticosteroids, diagnosis, musculoskeletal, polymyalgia rheumatica. Introduction Polymyalgia rheumatica PMR is an auto-inflammatory rheumatic disease of people over 50 years, presenting with pain and stiffness in the neck, shoulder and hip girdles 1. Table I Differences in treatment strategy underlining the need for identifying concomitant giant cell arteritis GCA in patients with polymyalgia rheumatic PMR.

Open in a separate window. How to Diagnose Polymyalgia Rheumatica? Musculoskeletal manifestations It is difficult to find PMR case without bilateral pain and stiffness of muscles and joints of neck, shoulder and hip girdles. Manifestations associated with inflammatory response or deterioration of general state It is surprising in PMR patient as to how intense inflammatory reaction in elderly may manifest.

Atypical presentations These are possible but frequently remain controversial. Diagnosis Based on the Classification Criteria Classification criteria are not developed for diagnosing but are generally used for this purpose.

Ultrasound Musculoskeletal ultrasound gains importance in rheumatology. Additional tests to help with the diagnosis There are no pathognomonic antibodies or other PMR-specific markers discovered. Diagnosis by Excluding Other Causes of Similar Symptoms The need for considering PMR exclusions was underlined in the previous criteria 37 and is also found in the current guidelines Differential diagnosis of conditions associated with musculoskeletal symptoms Differentiation between PMR and seronegative, elderly onset RA affecting proximal joints is actually a common reason for diagnostic uncertainty.

Differential diagnosis of conditions associated with inflammatory response or deterioration of general state Typical PMR age group is associated with a high risk of cancer. Diagnosis ex juvantibus Rapid and spectacular improvement shortly after CSs introduction enables concluding on a cause based on an observed response to the treatment. Conclusion Lack of specific biomarkers of PMR is problematic and research is needed.

Footnotes Conflicts of Interest: None. References 1. Nesher G. Polymyalgia rheumatica — Diagnosis and classification. J Autoimmun. Barber HS. Myalgic syndrome with constitutional effects; polymyalgia rheumatica. Ann Rheum Dis. Local and systemic immune response in nursing-home elderly following intranasal or intramuscular immunization with inactivated influenza vaccine.

Causes of death in polymyalgia rheumatica. A prospective longitudinal study of cases and matched population controls. Scand J Rheumatol. Epidemiology of polymyalgia rheumatica in Olmsted County, Minnesota, Arthritis Rheum. Chatterjee A, Das SK. Polymyalgia rheumatica and the risk of cerebrovascular accident.

Neurol India. Adverse outcomes of antiinflammatory therapy among patients with polymyalgia rheumatica. Giant cell arteritis in Mumbai. J Assoc Physicians India. Temporal arteritis: A case series from south India and an update of the Indian scenario. Ann Indian Acad Neurol. Polymyalgia rheumatica: years of epidemiological progress? Scott Med J. Milchert M, Brzosko M. Does Viking ancestry influence the distribution of polymyalgia rheumatica and giant cell arteritis in Poland?

Polymyalgia revealing eosinophilic fasciitis in a young male: Contribution of magnetic resonance imaging. Diagnosing polymyalgia rheumatica can be difficult because the symptoms are similar to those of many other conditions, including rheumatoid arthritis.

These conditions will need to be ruled out before polymyalgia rheumatica is diagnosed. The cause of polymyalgia rheumatica is unknown, but a combination of genetic and environmental factors is thought to be responsible.

Polymyalgia rheumatica is an age-related condition. Most people diagnosed with it are over 70, and it's very rare in people younger than It's also more common in women than men. It's estimated 1 in every 1, people in the UK develop the condition every year.