Polymyalgia rheumatica is a disorder that causes muscle pain and stiffness in your neck, shoulders, and hips. It is most common in women and almost always occurs in people over 50. The main symptom is stiffness after resting. Other symptoms include fever, weakness and weight loss. In some cases, polymyalgia rheumatica develops overnight. In others, it is gradual.
The cause is not known. There is no single test to diagnose polymyalgia rheumatica. Your doctor will use your medical history, symptoms, and a physical exam to make the diagnosis. Lab tests for inflammation may help confirm the diagnosis.
Polymyalgia rheumatica sometimes occurs along with giant cell arteritis, a condition that causes swelling of the arteries in your head. Symptoms include headaches and blurred vision. Doctors often prescribe prednisone, a steroid medicine, for both conditions. With treatment, polymyalgia rheumatica usually disappears in a day or two. Without treatment, it usually goes away after a year or more.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases
Background: PMR is a common inflammatory disorder of older adults that causes pain and stiffness in the shoulder and hip girdles and is usually accompanied by an acute phase response. Although previous research has considered potential causes of PMR, including infection and genetic susceptibility, there are no confirmed causal factors. This study aimed to describe patients’ opinions as to the causes of their PMR.
Methods: The PMR Cohort Study is an inception cohort of newly diagnosed PMR patients recruited from UK primary care between June 2012 and June 2014 (n = 654). Patients were sent a baseline postal questionnaire that included questions relating to general and PMR-specific health, demographics and lifestyle. It also included a question asking what the participants’ believe to be the cause of their PMR: ‘What do you think caused your PMR?’ Content analysis was used to identify and categorize patient responses.
Results: The responders’ mean age was 72.9 years (s.d. 9.2) and 405 (62%) were female. A total of 296 (45%) respondents answered the open question, 276 (42%) respondents wrote ‘no idea’ and 82 (13%) left the question blank. The 276 participants who answered the question had a mean age of 71.4 years (s.d. 9.9) and 63% were female. The non-responders/no idea group had a mean age of 73.0 years (s.d. 8.5) and 62% were female. Of the 296 that answered the question, 159 (54%) gave more than one causal factor and 137 (46%) gave a single cause. Thirty-eight potential causes were identified after data coding. These were further refined and grouped to give 11 main causes, including injury [n = 63 (17%)], personal stress [n = 53 (14%)], old age [n = 45 (12%)], worsening of existing musculoskeletal conditions [n = 40 (11%)], infection [n = 39 (10%)], occupational strain [n = 36 (9%)], related to other medical conditions [n = 24 (6%)], hereditary [n = 21 (55%)], medication [n = 18 (5%)], consequence of medical intervention [n = 16 (4%)], environmental [n = 14 (4%)] and lifestyle factors [n = 10 (3%)].
Conclusion: A range of factors were drawn upon by patients in describing the cause of their PMR, the most common relating to injury, personal stress, ageing and infection. Beliefs held by patients are known to influence coping and self-management strategies, particularly in chronic diseases such as PMR. These beliefs should be explored by doctors in order to correct those that are medically unlikely and to prevent unhelpful illness beliefs. Further studies are required to test some of these biologically plausible hypotheses regarding causes of PMR.
Disclosure statement: C.D.M. has received research funding from an Arthritis Research UK Clinician Scientist Award (grant number 19634), an NIHR Research Professorship (NIHR-RP-2014-04-026) and an NIHR Collaborations for Leadership in Applied Health Research Professorship (NIHR-RP-2014-04-026). All other authors have declared no conflicts of interest.
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