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Feature Article

Understanding and managing polymyalgia rheumatica

Claire E Owen, Vera Golder, Geoffrey O Littlejohn

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Abstract

Polymyalgia rheumatica is a chronic inflammatory disorder that affects the shoulder and pelvic girdle. Diagnosis is based on a clinical construct, and prednisolone remains the mainstay of treatment.

Key Points

  • Polymyalgia rheumatica (PMR) is the second most common inflammatory disorder affecting men and women over the age of 50 years.
  • The cardinal features of PMR are sudden-onset bilateral shoulder and pelvic girdle pain and stiffness, in combination with raised inflammatory markers.
  • About one-half of patients diagnosed with PMR exhibit distal manifestations including peripheral arthritis.
  • Concomitant giant cell arteritis can occur in 16 to 21% of patients with PMR.
  • A weaning course of prednisolone over one to two years remains the mainstay of treatment for patients with PMR.
  • Preventive health measures in patients with PMR should include assessment of bone health and treatment of modifiable cardiovascular risk factors.

    Picture credit: © SPL/Pixologicstudio

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