Inflammatory diseases in older adults: Polymyalgia rheumatica
Polymyalgia rheumatica (PMR) is a common inflammatory disease in adults over age 50, and particularly in women. Teasing apart the diagnosis of PMR from other inflammatory and degenerative diseases is mandatory because there are effective treatments for this reversible condition. Onset of PMR is usually acute, with pain typically beginning in the neck and upper arms, though it can begin in the pelvic girdle. Low grade fever may occur; swelling of the joints is not typical, although swelling of the knees may be present on occasion. There are no specific laboratory or radiographic findings although some consider an elevated sedimentation rate (> 50 mmg/hr) to be essential to diagnosis. Differential diagnoses can be myriad. Treatment, typically with prednisone (occasionally methylprednisolone), requires individualized regimens, particularly during tapering.