Medicine – Essential Features of Polymyalgia Rheumatica

Polymyalgia rheumatica is an inflammatory disorder that mainly affects older adults, particularly those between 60 and 70 years of age. It is characterised by pain and marked stiffness around the shoulder and hip girdles, especially in the morning. The condition is closely associated with giant cell arteritis and typically produces a strong inflammatory response, reflected by elevated inflammatory markers such as the erythrocyte sedimentation rate.

1. Age Group

Polymyalgia rheumatica occurs almost exclusively in older people and is most commonly seen in patients aged around 60–70 years. The likelihood of the condition increases with advancing age, and it is uncommon in younger adults.

2. Association with Giant Cell Arteritis

There is a strong relationship between polymyalgia rheumatica and giant cell arteritis. Around 25% of patients may have associated giant cell arteritis. Because of this connection, patients should be assessed for symptoms such as new headache, scalp tenderness, jaw claudication, or visual disturbance, as untreated giant cell arteritis can threaten vision.

3. Raised ESR and Alkaline Phosphatase

Laboratory investigations usually demonstrate evidence of systemic inflammation. The erythrocyte sedimentation rate is typically raised, and some patients also have an increase in alkaline phosphatase, reported in about 30% of cases. These abnormalities support the diagnosis but should always be interpreted together with the clinical picture.

4. Rapid Response to Steroids

A characteristic feature of polymyalgia rheumatica is the rapid improvement of both symptoms and inflammatory markers after corticosteroid treatment. Patients often experience a striking reduction in pain and stiffness within a short period after starting therapy. The ESR also tends to fall as the inflammatory process comes under control, and this response can provide useful support for the diagnosis.

Clinical Features

1. Sudden Onset of Proximal Symptoms

The illness often begins suddenly, with prominent symptoms affecting the proximal muscles and girdle regions. Patients commonly report difficulty moving the shoulders or hips, particularly after periods of rest. The discomfort is usually most severe in the morning and can make activities such as getting out of bed, dressing, or raising the arms difficult. Although patients may describe weakness, the main problem is usually pain and stiffness rather than true loss of muscle power.

2. Weight Loss

Some patients develop unintentional weight loss as part of the systemic inflammatory illness. This may occur together with constitutional symptoms such as malaise, reduced appetite, or low-grade fever.

3. Joint Pain

Joint pain may accompany the more typical shoulder and hip girdle symptoms. The pain can contribute to reduced mobility and functional limitation, although marked destructive arthritis is not a typical feature of polymyalgia rheumatica.

4. Symptoms of Giant Cell Arteritis

Patients may also present with manifestations of giant cell arteritis, including headache, scalp tenderness, jaw pain during chewing, or visual symptoms. These features are clinically important because giant cell arteritis requires urgent treatment to reduce the risk of serious complications such as permanent visual loss.