Prof.

Shorena Chumburidze
 Idiopathic, inflammatory disorder of pain,
ASSOCIATED WITH PROXIMAL MUSCLES.

 Abrupt onset

 Self- limited

 Unlike polymiositis/dermatomiositis, the key

feature is pain, and not too much weakness
 Very common disease among elderly, affecting
approximately 52.5/100,000

 Whites are affected more than blacks 2:1.

Woman affected more than men

 There is a high correlation between polymyalgia

rheumatica and temporal (giant cell) arteritis.

 This is a syndrome of the elderly (50+)

 Nearly half of patients w/temporal (giant cell)

arteritis have, or will have PR
 Pts will describe general aches and pains,
stiffness, especially of the upper arms,
shoulders, and hip girdle

 The pain tends to be worst in the morning

 Normal strength (however exerting more
strength may elicit pain)

 Active range of motion is limited by pain

 Clinical and of exclusion

 The best initial test would be an ESR , which

would be elevated

 It is at this point you begin therapy

 Oral corticosteroids, namely, prednisone

 Pts w/PR typically have a rapid response to

corticosteroids

 The steroids can be tapered down to the lowest

effective dose
 All pts w/PR should be assessed for sx related to
temporal arteritis, due to the high association

 Pts w/sx of temporal arteritis will require a

temporal artery biopsy for confirmation and
consultation with an ophthalmologist. However,
the tx (w/prednisone) is the same
 Imagining does not play a significant role in
diagnosing PR.

 However, MRI has shown that the inflammation is

more around the bursa and tendon, rather, than
inside the muscle itself
 Starting >10mg  fewer relapses, shorter
treatment periods than compared to <10mg

 Starting >15mg lead to higher cumulative

doses and more steroid adverse affects

 Tapering lead to more successful treatment,

fewer relapses, when done slowly (1mg/mo)
 Overall, benign disease
 Self limited and most resolve within 1-3

years, however patients experience

significant decrease in quality of life
 50-75% of patients can often be weaned off

all steroids by 3 years

◦ If relapse, often occurs within 12 months of
weaning steroids
 Need to be monitored for TA