Polymyalgia rheumatica in older adults

Abstract

Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease in the elderly. The incidence of PMR increases markedly with advancing age. It is characterized by abrupt-onset pain and stiffness of the shoulder and pelvic girdle muscles. There are several conditions that can mimic PMR, making the evaluation of PMR challenging. The majority of PMR is usually diagnosed in the primary care setting, but standard clinical investigations and referral pathways for suspected PMR are unclear. There are wide variations in the management of PMR. Additionally, the response to standardized therapy is heterogeneous and a significant number of patients fail to respond completely. There is also an overlap with inflammatory arthritis and large vessel vasculitis for which adjuvant disease-modifying medications are often used. Prolonged corticosteroid therapy is associated with a variety of side effects, particularly when high-dose glucocorticoid therapy is employed. Diagnosis and management of PMR requires a detailed knowledge of the disease, its differential diagnoses and the therapeutic options. The purpose of this article is to discuss the major clinical issues specific to the assessment and management of PMR in older adults.