Systemic (Rheumatic)
Polymyalgia Rheumatica (PMR)
류마티스성 다발근통
Inflammatory disease with bilateral shoulder/pelvic girdle pain, morning stiffness, and elevated ESR
- How common
- 1–2 per 1,000 adults >50
- Typical age
- Age >50, average 70s
What is it?
Immune-mediated synovitis and bursitis around shoulder/pelvic girdles; muscles themselves are spared (strength preserved).
Commonly affected: Shoulder, neck, and pelvic girdle synovia and bursae
How it develops
- Age-Related Immune ShiftIncreased IL-6 and inflammatory cytokines in elderly
- Proximal Synovitis/BursitisSubacromial, subdeltoid, trochanteric bursitis
- Systemic InflammationMarked ESR/CRP elevation
- Possible GCA Overlap10–20% develop giant cell arteritis — vision loss risk
Symptoms
- Bilateral shoulder painSymmetric shoulder/upper arm pain
- Bilateral hip girdle painHip and upper thigh pain
- Morning stiffness >45 minSevere stiffness lasting >1 hour
- Functional impairmentDifficulty raising arms, rising from chair
- Constitutional symptomsLow-grade fever, weight loss, fatigue
How it is examined
- Restricted shoulder/hip ROMDecreased active abduction/flexion (pain-limited)
- Preserved muscle strengthStrength preserved on passive testing (not true weakness)
- Elevated ESR ≥40 + CRPKey lab finding in PMR; ESR 50–100 common
- Dramatic steroid responsePrednisolone 15 mg/day → response within 24–72 hours
Imaging
X-ray usually normal; used to exclude other arthritides.
- Normal joints
- No erosions
- May show degenerative changes
US/MRI shows subacromial-subdeltoid bursitis, bicipital tenosynovitis, trochanteric bursitis.
- Subacromial-subdeltoid bursitis
- Bicipital tenosynovitis
- Hip synovitis
- Trochanteric bursitis
Non-surgical care
- Low-dose corticosteroidsPrednisolone 15 mg/day, gradual taper over 1–2 years
- Methotrexate (steroid-sparing)Add for relapse or steroid intolerance
- Tocilizumab (IL-6 inhibitor)Consider for refractory/relapsing PMR
- Osteoporosis prophylaxisCalcium, vitamin D, bisphosphonates (for chronic steroid use)
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
No surgical indication
Procedures that may be discussed
- Pharmacologic management only
Outlook
Most achieve remission within 1–2 years; 30–50% relapse. Watch for GCA complication.