5-Minute Clinical Consult
Polymyalgia Rheumatica
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Basics
Description
- A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck; primarily impacts the elderly, associated with morning stiffness and elevated markers of inflammation
- System(s) affected: musculoskeletal; hematologic/lymphatic/immunologic
- Synonym(s): senile rheumatic disease; polymyalgia rheumatica (PMR) syndrome; pseudo-polyarthrite rhizomélique
- Incidence increases with age.
- Average age of onset ~70 years
Pediatric Considerations
Rare in patients <50 years of age. The peak incidence of PMR is between ages 70 and 80 years (1).
Epidemiology
Incidence- Incidence increases after age 50 years. Incidence of PMR and giant cell arteritis (GCA) in the United States is 50 and 18 per 100,000 people, respectively.
- Predominant sex: female > male (2 to 3:1)
- Most common in Caucasians, especially those of northern European ancestry
Prevalence
Prevalence in those >50 years old: 700/100,000
Etiology and Pathophysiology
- Unknown. Symptoms relate to enhanced immune system and periarticular inflammatory activity.
- Pathogenesis
- Polygenic; involves multiple environmental and genetic factors
- Significant association between histologic evidence of GCA and parvovirus B19 DNA in temporal artery specimen
Genetics
Associated with human leukocyte antigen determinants (HLA-DRB1*04 and DRB1*01 alleles)
Risk Factors
- Age >50 years
- Presence of GCA
Commonly Associated Conditions
Concurrent GCA (temporal arteritis) in ~15–30% of patients; more commonly in females than males
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Basics
Description
- A clinical syndrome characterized by pain and stiffness of the shoulder, hip girdles, and neck; primarily impacts the elderly, associated with morning stiffness and elevated markers of inflammation
- System(s) affected: musculoskeletal; hematologic/lymphatic/immunologic
- Synonym(s): senile rheumatic disease; polymyalgia rheumatica (PMR) syndrome; pseudo-polyarthrite rhizomélique
- Incidence increases with age.
- Average age of onset ~70 years
Pediatric Considerations
Rare in patients <50 years of age. The peak incidence of PMR is between ages 70 and 80 years (1).
Epidemiology
Incidence- Incidence increases after age 50 years. Incidence of PMR and giant cell arteritis (GCA) in the United States is 50 and 18 per 100,000 people, respectively.
- Predominant sex: female > male (2 to 3:1)
- Most common in Caucasians, especially those of northern European ancestry
Prevalence
Prevalence in those >50 years old: 700/100,000
Etiology and Pathophysiology
- Unknown. Symptoms relate to enhanced immune system and periarticular inflammatory activity.
- Pathogenesis
- Polygenic; involves multiple environmental and genetic factors
- Significant association between histologic evidence of GCA and parvovirus B19 DNA in temporal artery specimen
Genetics
Associated with human leukocyte antigen determinants (HLA-DRB1*04 and DRB1*01 alleles)
Risk Factors
- Age >50 years
- Presence of GCA
Commonly Associated Conditions
Concurrent GCA (temporal arteritis) in ~15–30% of patients; more commonly in females than males
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