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Clinical Characteristics of Polymyalgia Rheumatica
The Docken criteria:
Older adult
Abrupt onset
AM stiffness
Proximal polyarthralgias: upper arms, thighs, neck
Seronegative
ESR usually elevated
Brisk response to low dose steroids
Not erosive
Whites > Polymalgia Rheumatica blacks, Asian; seven times more common in whites than blacks
Females > Males
> 50 years old. Mean age of onset approx. 70 years; range 50-90 polymyalgia rheumatica, polymialgia, rumatica
Incidence: 52.5/100,000
A common problem in the elderly
Occasional familial cases
Pathophysiology
Muscle is normal:
Normal enzymes
Normal EMG
Essentially normal biopsy
Myopathies usually don't hurt; arthropathies often do. Myopathies usually present with painless weakness.
PMR is an arthritis:
AM stiffness is common and is a cardinal clinical feature of many systemic rheumatic diseases
Hip and shoulder arthritis often results in referred pain to the thighs and upper arms, respectively
muscle tenderness to direct palpation is an unreliable physical sign
Carpal tunnel syndromes are common
Direct evidence for synovitis
Physical examination reveals sinovitis
Synovial fluid analysis (synovial fluid wbc is variable, up to 21,000 cells/cc)
Arthroscopy - Evidence for synovitis at the shoulder; mild to moderate synovial proliferation and chronic inflammation, generally less polymyalgia rheumatica , polymialgia, rumatica