Pain in the Neck, Shoulders and Hips
Polymyalgia Rheumatica or PMR is an inflammatory disorder of unknown origin, characterized by aching, pain and stiffness in the shoulders, upper arms, neck and hip region. The term polymyalgia comes from the Greek and means pain (algia) in many (poly) muscles (my or myo). It is often accompanied by fatigue and malaise and is a fairly common cause of widespread aching and stiffness in older adults. The stiffness is particularly prominent in the morning. PMR almost always occurs after the age of 50 (most commonly after the age of 65) and women are affected two times as often as men. Onset typically begins rapidly over about two weeks with pain in both shoulders and in the neck, progressing to the hips over weeks to months and eventually making it difficult to perform daily activities. Occasionally the onset is abrupt with symptoms appearing almost overnight.
Pathophysiology
The inflammation in Polymyalgia Rheumatica is thought to occur in the bursae or sacs around the shoulder and hip joints. PMR is closely related to a more serious inflammatory disorder, called Giant Cell Arteritis or GCA, which involves the arteries of the head and neck and can lead to headaches, jaw pain and visual disturbances. GCA is classified as a vasculitis, which means there is inflammation in the blood vessel walls leading to vessel narrowing, blockage or even aneurysm or rupture. Heredity may play a role in the development of both PMR and GCA and it is theorized that infection may set the wheels in motion. For example, a virus may stimulate the immune system and trigger PMR in a susceptible individual. Because PMR and CGA are thought to be manifestations of the same disease, a patient may have both conditions.
Diagnosis
Due to involvement of the shoulders and hips, individuals with Polymyalgia Rheumatica typically have difficulty with certain specific activities, such as getting out of bed, standing up from a chair, getting out of a car or putting on a coat. Symptoms of PMR may also include loss of appetite, weight loss and low grade fever. There are several laboratory tests that help in identifying PMR. Although it is a nonspecific indication of inflammation, the erythrocyte sedimentation rate, or ESR, is usually significantly elevated. Another blood test measuring the level of C-reactive protein or CRP is often quite high in patients with Polymyalgia Rheumatica. CRP is a protein formed in the liver in response to injury, infection or inflammation. Patients may also have anemia.
Treatment and Prognosis
Patients with Polymyalgia Rheumatica often respond rapidly and dramatically to low dose steroid medications, such as 10 to 20 mg of prednisone a day. Relief from the pain and stiffness within a few days helps confirm the diagnosis of PMR. Treatment typically lasts for several years with careful tapering of the prednisone to avoid recurrence. Patients must also be monitored for signs and symptoms of Giant Cell Arteritis which is thought to be another manifestation of the same disease, but which can have serious consequences, such as stroke and sudden blindness. Fortunately, Polymyalgia Rheumatica often goes away on its own within 2 to 6 years, after which time treatment can be stopped.