Welcome to the Rare Classroom, a new series from Patient Worthy. Rare Classroom is designed for the curious reader who wants to get informed on some of the rarest, most mysterious diseases and conditions. There are thousands of rare diseases out there, but only a very small number of them have viable treatments and regularly make the news. This series is an opportunity to learn the basics about some of the diseases that almost no one hears much about or that we otherwise haven’t been able to report on very often.

Eyes front and ears open. Class is now in session.

The disease that we will be learning about today is:

Polymyalgia Rheumatica

What is Polymyalgia Rheumatica?

• Polymyalgia rheumatica (sometimes referred to as PMR) is a common cause of widespread aching and stiffness that affects adults over the age of 50
• Because polymyalgia rheumatica does not often cause swollen joints, it may be hard to recognize. It may occur with another health problem, giant cell arteritis, which can cause headaches, vision difficulties, jaw pain and scalp tenderness. It’s possible to have both of these conditions together​
• Symptoms usually begin quickly and are worse in the morning.​
• The average age when symptoms start is 70, so people who have PMR may be in their 80s or even older ​
• The disease affects women twice as often as men. It is more frequent in whites than nonwhites, but all races can get PMR​
• The incidence increases with advanced age. PMR rarely affects persons younger than 50 years. The median age at diagnosis is 72 years​
• Not considered rare overall (more than 200,000 cases in the US yearly)

How Do You Get It?

• The cause of polymyalgia rheumatica (PMR) is unknown​
• PMR does not result from side effects of medications​
• The abrupt onset of symptoms suggests the possibility of an infection but, so far, none has been found ​
• “Myalgia” comes from the Greek word for “muscle pain” However, specific tests of the muscles, such as a blood test for muscle enzymes or a muscle biopsy (surgical removal of a small piece of muscle for inspection under a microscope), are all normal​
• Recent research suggests that inflammation in PMR involves the shoulder and hip joints themselves, and the bursae (or sacs) around these joints. So pains at the upper arms and thighs, in fact, start at the nearby shoulder and hip joints. This is what doctors call “referred pain”​

What Are The Symptoms?

• Aches or pain in your shoulders (often the first symptom)​
• Aches or pain in your neck, upper arms, buttocks, hips or thighs​
• Stiffness in affected areas, particularly in the morning or after being inactive for a long time​
• Limited range of motion in affected areas​
• Pain or stiffness in your wrists, elbows or knees (less common)​
• General Symptoms​
  • Mild fever​
  • Fatigue​
  • A general feeling of not being well (malaise)​
  • Loss of appetite​
  • Unintended weight loss​
  • Depression​

How Is It Treated?

• Corticosteroids​
  • Treatment begins with a daily dose, but can be decreased after the first 2-4 weeks if one is responding to treatment ​
    • Prednisone, prednisolone
  • Most people with polymyalgia rheumatica need to continue the corticosteroid treatment for at least a year. ​
  • People who taper off the medication too quickly are more likely to have a relapse. ​
  • 30-60 percent of people with polymyalgia rheumatica will have at least one relapse when tapering off the corticosteroids​
• Methotrexate (Trexall)​
  • This is an immune-suppressing medication that is taken by mouth. It may be useful early in the course of treatment or later, if you relapse or don’t respond to corticosteroids.​
• Physical therapy​

Where Can I Learn More???

• Check out our cornerstone on this disease here.