Clinical Review

Polymyalgia rheumatica

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6937 (Published 03 December 2013) Cite this as: BMJ 2013;347:f6937
  1. Sarah L Mackie, clinical lecturer1,
  2. Christian D Mallen, professor2
  1. 1National Institute for Health Research-Leeds Musculoskeletal Biomedical Research Unit, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds LS7 4SA, UK
  2. 2Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
  1. Correspondence to: S L Mackie s.l.mackie{at}leeds.ac.uk

Summary points

  • Polymyalgic syndrome can be a presenting feature of a wide range of diseases, including giant cell arteritis and rheumatoid arthritis

  • Look for other diseases before starting glucocorticoids (≤20 mg prednisolone or equivalent)

  • Carefully document the speed, completeness, and nature of the response to initial glucocorticoid treatment

  • Atypical features should prompt early specialist evaluation

  • Monitor patients carefully for adverse effects of glucocorticoids and taper drugs on an individual basis

Polymyalgia rheumatica causes pain and stiffness that is worst in the morning and particularly affects the shoulders and hips. It is a treatable cause of profound debility and functional impairment.1 The condition usually presents to primary care and is the most common inflammatory musculoskeletal disease in older people, with an age adjusted incidence of about one in 1000 person years.2 The lifetime risk has been estimated at 2.4% for women and 1.7% for men.3 There is little trial based evidence to guide diagnosis and treatment. This review describes current ideas about best practice in the diagnosis and management of this disease, drawing on recent clinical guidelines4 and highlighting some research priorities.

Sources and selection criteria

We searched Medline, Embase, Cochrane Collaboration, and ClinicalTrials.gov using the word “polymyalgia”. All study types were included owing to the limited amount of literature available.

What is polymyalgia rheumatica?

The site of pathology is unclear and little is known about the causes and pathogenesis of this disease. The clinical diagnosis can be challenging owing to the lack of a specific diagnostic test. Various diagnostic and classification criteria have been proposed.5 6 7 8 9 Classification criteria have recently been developed by the European League against Rheumatic Diseases and the American College of Rheumatology on the basis of a large prospective, international multicentre study and data driven consensus process. These are currently awaiting validation in an independent dataset (table 1

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