Clinical Review

Polymyalgia rheumatica

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39514.653588.80 (Published 03 April 2008) Cite this as: BMJ 2008;336:765
  1. Clement J Michet, associate professor of medicine ,
  2. Eric L Matteson, professor of medicine
  1. 1Division of Rheumatology, Mayo Clinic, Rochester, MN 55905, USA
  1. Correspondence to: E L Matteson matteson.eric{at}mayo.edu

    Polymyalgia rheumatica is the most common inflammatory rheumatic disease in elderly white people, and it is a common indication for long term treatment with glucocorticosteroids in patients based in the community.1 2 Although the symptoms are very characteristic, several other autoimmune, infectious, endocrine, and malignant disorders can present with similar symptoms. The course of disease is heterogeneous and unpredictable, and giant cell arteritis is seen in about 30% of patients.3 Glucocorticosteroids rapidly improve disease symptoms in most patients but may have serious side effects. This review looks at the current understanding of diagnosis and the management of polymyalgia rheumatica.

    Sources and selection criteria

    We searched PubMed, Embase, Scopus, Premedline, and National Institutes for Health Clinical Trials publications from 2000 to 2007 for strategies for the diagnosis and management of polymyalgia rheumatica. We found no Cochrane reviews on the subject.

    Who is at risk of polymyalgia rheumatica?

    Polymyalgia rheumatica is seen mainly in people of north European ancestry, although it can occur in any ethnic group. It is almost never seen in people under the age of 50, and its prevalence increases with increasing age. The average age of onset is just over 70, and 75% of patients are women. The incidence of the disease in patients over 50 is about 100 per 100 000.1 2

    Summary points

    • Polymyalgia rheumatica occurs in patients who on average are over 70 years of age

    • Cardinal symptoms are shoulder and hip girdle pain with pronounced stiffness lasting at least one hour

    • Clinicians must be alert to mimics, including infection, malignancy, metabolic bone disease, and elderly onset rheumatoid arthritis

    • Erythrocyte sedimentation rate or C reactive protein, or both, is usually raised at disease onset

    • Giant cell arteritis is present in about 30% of patients

    • Polymyalgia rheumatica is treated with glucocorticosteroids, starting at 15 mg prednisone a day

    What is the pathogenesis of polymyalgia rheumatica?

    The cause of polymyalgia rheumatica is unknown, although both …

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