Polymyalgia rheumatica (PMR) is a systemic inflammatory disease characterized by pain or stiffness, usually in the

neck The neck is the part of the body in many vertebrates that connects the head to the torso. It supports the weight of the head and protects the nerves that transmit sensory and motor information between the brain and the rest of the body. Addition ...

, shoulders, upper arms, and

hips In vertebrate anatomy, the hip, or coxaLatin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) (: ''coxae'') in medical terminology, refers to either an anatomical region or a joint ...

, but which may occur all over the body. Almost all cases occur in people age 50 or older. Pain and stiffness of PMR is worst in the morning and improves throughout the day, but these symptoms frequently persist to some extent throughout the day and into the evening. People who have polymyalgia rheumatica may also have temporal arteritis (

giant cell arteritis Giant cell arteritis (GCA), also called temporal arteritis, is an inflammatory autoimmune disease of large blood vessels. Symptoms may include headache, pain over the temples, flu-like symptoms, double vision, and difficulty opening the mout ...

), an inflammation of blood vessels in the face which can cause blindness if not treated quickly. The pain and stiffness can result in a lowered quality of life, and can lead to depression. The exact cause of PMR, including whether or not it may be an

autoimmune disease An autoimmune disease is a condition that results from an anomalous response of the adaptive immune system, wherein it mistakenly targets and attacks healthy, functioning parts of the body as if they were foreign organisms. It is estimated tha ...

, is unclear. Persons of Northern European descent are at greater risk. There is no definitive laboratory test, but C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can be useful as non-specific markers of systemic inflammation. PMR is usually treated with

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s taken by mouth. Most people need to continue the corticosteroid treatment for two to three years. PMR sometimes goes away on its own in a year or two, but medications and

self-care Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, ...

measures (e.g., eating the recommended amount of fruits and vegetables) can improve the rate of recovery. PMR was first established as a distinct disease in 1966 by a case report on 11 patients at Mount Sinai Hospital in New York City. It takes its name from the

Greek Greek may refer to: Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group *Greek language, a branch of the Indo-European language family **Proto-Greek language, the assumed last common ancestor of all kno ...

word Πολυμυαλγία ''polymyalgia'', which means "pain in many muscles".

Signs and symptoms

A wide range of symptoms can indicate if a person has polymyalgia rheumatica. The classic symptoms include: * Pain and stiffness (moderate to severe) in the neck, shoulders, upper arms, thighs, and hips, which inhibits activity, especially in the morning, but which usually persists to some degree throughout the day. Pain can also occur in the groin area and in the buttocks. The pain can be limited to one of these areas as well. It is a disease of the "girdles" meaning shoulder girdle or pelvic girdle. *

Fatigue Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself. Fatigue (in the medical sense) is sometimes associated wit ...

and lack of appetite (possibly leading to weight loss) *

Anemia Anemia (also spelt anaemia in British English) is a blood disorder in which the blood has a reduced ability to carry oxygen. This can be due to a lower than normal number of red blood cells, a reduction in the amount of hemoglobin availabl ...

* An overall feeling of illness or flu-like symptoms. * Low-grade (mild) fever or abnormal temperature is sometimes present. ** High or spiking fevers may occur in patients who also have

. * Generalized weakness ** Note that this is ''generalized'' weakness, not ''muscle'' weakness. The presence of muscle weakness likely indicates a different diagnosis. * Inflammatory swelling and pain of wrists and/or knees (only ~25% of cases) * Pitting edema (non-inflammatory swelling) of wrists, ankles, hands, and feet (only ~10% of cases)

Temporal arteritis

About 20% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis (also called ''giant cell arteritis''), and about 50% of people with temporal arteritis have polymyalgia rheumatica. Some symptoms of temporal arteritis include

headaches A headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Head ...

, scalp tenderness, jaw or facial soreness, distorted vision, or aching in the limbs caused by decreased blood flow, and fatigue.

Causes

The pathophysiology of polymyalgia rheumatica is not well-understood. Evidence shows that there is likely a combined genetic and environmental pathophysiology behind the disease, but concrete identification of the causes, including whether or not polymyalgia rheumatica is an

, remains elusive. It is, at the very least, an immune-''mediated'' disease, with both

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