Polymyalgia rheumatica (PMR)

Polymyalgia rheumatica is an inflammatory rheumatic disease almost exclusively of adults over 50 (mean age 70, female 2:1). It causes symmetric severe pain and stiffness of the shoulder girdle, neck and hip girdle, worst on waking, with profound functional limitation (patients can't lift their arms to dress, can't rise from chairs). Constitutional symptoms — fatigue, weight loss, low-grade fever — are common. ESR and CRP are characteristically very high (ESR often >50 mm/h). The relationship to giant cell arteritis (GCA) is critical: 10–20% of PMR patients develop GCA, and 50% of GCA patients have PMR — every PMR patient must be questioned for headache, jaw claudication, visual disturbance, and scalp tenderness, because GCA can cause irreversible blindness if untreated. Response to low-dose prednisone (15-20 mg) is typically dramatic within 1-3 days and is part of the diagnostic criteria.

• CRP — high, often >20–50 mg/L; mirrors disease activity for monitoring.
• ESR — characteristically very high (>40, often >70 mm/h); the classic PMR lab.
• Full blood count — normocytic anaemia of chronic disease common.
• Creatinine, ALT — baseline before steroid therapy (long-term steroids affect kidney perfusion and liver enzymes).
• TSH, calcium, vitamin D — rule out alternatives (hypothyroidism, vitamin D deficiency mimic PMR-like symptoms).
• Rheumatoid factor, anti-CCP, ANA — typically negative; rule out RA, lupus.

• Bilateral shoulder, neck and hip-girdle pain and stiffness
• Severe morning stiffness lasting >45 min (often >2 hours)
• Difficulty rising from chair, lifting arms above shoulders, turning in bed
• Fatigue, weight loss, low-grade fever
• Watch for GCA: new headache, jaw claudication, transient visual loss, scalp tenderness