Polymyalgia rheumatica

Polymyalgia rheumatica typically manifests as inflammatory pain in the shoulder and / or pelvic girdles in a patient over 50 yrs of aget ( PMR ) is the most common inflammatory rheumatic disease in the elderly and is one of the biggest indications for long term steroid therapy

Pathophysiology- Poorly understood Polygenic inflammatory disorders ( PMR & GCA ) with several genetic & environmental factors likely influencing patient susceptibility & disease severity Closely linked to GCA ( Giant cell arteritis ) About one half of patients affected by GCA also meet diagnosticcriteria of PMR - however only about 10 % of patients with PMRalso have GCAso it is thought that mechanisms which contribute to GCA may be involved as genetically predisposed individual - an environment factor possibly virusPathologically GCA and PMR- similarMain difference - absence of significant vascular involvement in PMR PMR- no evidence of disease in muscle biopsy A mild synovitis with macrophages and CD4 + T cell infiltration in the glenohumeral jt ( systemic macrophages and T-cell activation are seen in both GCA and PMR ) Increased pro-inflammatory cytokines and melatonin

Epidemiology-Highest in individuals with Northern European descent - more in Scandinavian people than other white population Women...