Polymyalgia rheumatica

Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with stiffness, weakness and pain in the shoulder and pelvic girdles, together with a high erythrocyte sedimentation rate and CRP. It is closely linked to temporal arteritis, which affects the blood vessels of the neck, head and aortic arch and can lead to ischaemia, stroke and ophthalmic artery thrombosis.

The symptoms are non-specific, with a headache that is usually one-sided. It is more common in older people and sometimes occurs seasonally, which suggests that an external infectious factor may play a part in its development; but as it is a multifactorial disease, other factors – and especially the interplay between them – cannot be ruled out either. Patients find it hard to get up from a chair or rise from a squat, and raising the shoulders is particularly difficult.

Treatment with corticosteroids is essential; methotrexate is introduced as a steroid-sparing medicine if high doses of glucocorticoids have to be prescribed. Newer biological medicines such as anakinra, an interleukin blocker, have proved very effective. Once the disease is in remission, it needs to be monitored for at least two years before an attempt is made to stop the medicine.

Key features:
– pain and stiffness in the shoulder and pelvic girdles
– older people
– constitutional symptoms
– arthritis
– raised sedimentation rate
– temporal arteritis

Monitoring inflammatory rheumatic diseases is a key factor in treatment, as is close follow-up of the patient's symptoms and laboratory results and the use of imaging methods such as X-ray, ultrasound and magnetic resonance imaging, with which we follow morphological changes in the affected tissue, organ or organ systems.