Polymyalgia rheumatica

Polymyalgia rheumatica is a chronic, infl ammatory disorder of unknown cause that aff ects people over age 50 years. Classic symptoms include pain and long-term morning stiff ness of the neck, shoulders, hips, upper arms, and thighs. Although markers of infl ammation are often raised, no specifi c laboratory test exists for the disorder and the diagnosis is based on clinical assessment. Provisional classifi cation criteria were published in April, 2012, by a collaborative initiative of the European League Against Rheumatism and the American College of Rheumatology. Several other disorders can mimic polymyalgia rheumatica. In particular, clinical manifestations can be diffi cult to diff erentiate from other forms of infl ammatory arthritis such as spondyloarthritis and rheumatoid arthritis. Imaging studies such as ultrasonography and MRI typically show a predominantly periarticular infl ammatory process. A subset of patients has an associated infl ammatory vasculopathy aff ecting large arteries (giant cell arteritis). The standard treatment is low-dose glucocorticoids, which provide symptomatic relief for most patients. However, disease relapses are common, and treatment with glucocorticoids is associated with substantial morbidity. Improved understanding of disease pathogenesis might allow for more targeted immunotherapy.