Disease Burden, Quality of Life and Other Measures in Polymyalgia Rheumatica

Abstract:

Polymyalgia rheumatica (PMR) is the most common inflammatory rheumatic disease occurring principally in elderly Caucasians and a common indication for long-term glucocorticosteroid therapy in community-based patients.

Although PMR has very characteristic symptoms, there are number of other autoimmune, infectious, endocrine and malignant disorders which may present with polymyalgia like symptoms. It is important to make the diagnosis in a safe step-wise manner based on “essential” symptoms such as bilateral shoulder/hip pain and stiffness in people above 50 years age; “essential” exclusions such as active infection or cancer; clinical evaluation and minimum laboratory investigations to exclude other mimics and careful evaluation of clinical and laboratory response to low-dose steroids.

The most commonly associated inflammatory condition is giant cell arteritis, which can occur in a minority of patients. The course of disease is heterogeneous and unpredictable. Glucocorticosteroid treatment results in a rapid improvement in disease symptoms in most patients but may be associated with significant side effects. Quality of life of patients with PMR is influenced early in the disease course by the initial pain, stiffness and functional limitations caused by joint involvement and systemic symptoms, and later especially by treatment related adverse effects. Life expectancy in patients with polymyalgia rheumatica is equivalent to that of the general population.

In view of the uncertainty associated with diagnosis, flexibility of treatment required depending on course and treatment side effects – we recommend that patients should be managed in a “seamless” manner across primary and secondary care with early rheumatology evaluation recommended in all atypical cases. There is a large unmet need for improvement in management and research on PMR.