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Introduction

Polymyalgia rheumatica (PMR) is an inflammatory disorder that occurs almost exclusively in patients age ≥50 and is characterized by aching pain and stiffness involving the shoulders and hips.  A rapid response to glucocorticoids supports the diagnosis, but a prolonged treatment course is typically required.  PMR is associated with giant cell (temporal) arteritis (GCA), a vasculitis of large vessels that can lead to blindness; therefore, patients with PMR must be monitored for manifestations of GCA.

Pathophysiology

The exact pathophysiology of PMR is unclear.  Despite the name polymyalgia, suggesting a myopathic process, PMR is in fact an inflammatory disorder of the proximal joints, bursae, and tendons; the muscle itself is unaffected.  Both PMR and GCA are linked to specific HLA alleles and have similar T-cell distributions (decreased regulatory T cells, elevated T helper 17 cells) along with levels of the inflammatory cytokine interleukin-6.  Environmental factors (eg, infection, seasonal changes) may play a role.

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