1. POLYMYALGIA
RHEUMATICA
Dr. Arshad Rabbani
MBBS,MCPS,FCPS

2. is a clinical syndrome characterized by severe
aching and stiffness in the neck, shoulder
girdle, and pelvic girdle.

3. Pathophysiology
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causes severe pain in the proximal muscle
groups; however, no evidence of disease is
present at muscle biopsy.
Muscle strength and electromyographic
findings are normal.
cell-mediated injury to the elastic lamina in the
blood vessels in the affected muscle groups.

4. Incidence
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Frequency
1 in 200 people aged 50 years or older.
Mortality/Morbidity
not a life-threatening disease, but it does
require treatment for 2-4 years.
Race
whites >other ethnic groups
Sex
Females are affected twice as often as males.

5. Symptoms
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Pain and stiffness in the proximal muscle groups
that usually is symmetrical and worse in the
morning.
Gel phenomenon (stiffness after prolonged
inactivity).
Fever (low grade).
Weight loss.
Fatigue.
Depression.
No weakness.
Abrupt onset of symptoms.

6. Signs
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No muscle atrophy.
Muscle tenderness.
Decreased active range of motion of joints
secondary to pain.

7. Lab studies
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Erythrocyte sedimentation
rate greater than 50 mm/h
Normochromic normocytic
anemia in 50% of cases
Normal creatinine kinase
level
Negative finding for
rheumatoid factor
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Mild elevations with liver
function test results
Mild nonspecific synovitis
Negative muscle biopsy
findings

8. Treatment
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Corticosteroids e.g. prednisone
5-60 mg/d PO qd or divided bid/qid; taper
over 2 wk as symptoms resolve.

9. Prognosis
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The average length of disease is 3 years.
Exacerbations may occur if steroids are
tapered too rapidly.
Relapse is common.