Polymyalgia Rheumatica: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate polymyalgia rheumatica (PMR):

  • Girdling myalgia (muscle pain), symmetrically occurring, primarily affecting:
  • Pressure painfulness
  • Stiffness of the muscles, especially long-lasting morning stiffness (> 45 min).
  • Weakness of the musculature
  • General symptoms (fever, anorexia (loss of appetite), weakness and/or weight losst: average 6 kg) (40%).
  • Peripheral manifestations:
    • Bilateral (bilateral) bursitis (bursitis) subdeltoid (between the joint capsule of the shoulder joint and the deltoid muscle)/subacromialis (under the coracoid process (acromion) of the shoulder blade)
    • Non-osseous, asymmetric mono-, oligo-, or polyarthritis/joint inflammation (esp. knee and wrist joints)
    • Carpal tunnel syndrome (KTS) – compression syndrome (narrowing syndrome) of the median nerve in the region of the carpal canal.
    • Back of the hand edema / water retention on the back of the hand (possibly also foot back edema).
    • Tenosynovitis (tendonitis) of the knee, hand or finger joints.

Polymyalgia rheumatica is associated with giant cell arteritis in 20-50% of cases.

The following symptoms and complaints may indicate giant cell arteritis (RZA):

  • The following symptoms and complaints may indicate giant cell arteritis (RZA):

    • due toInvolvement of the cranial vessels (approximately 70% of patients):
      • Severe constant headache (60-90% of those affected); hemifacial or bilateral, especially bitemporal (in the temporal region; tension-type headache) – the initial symptom in 48% of cases; usually responds poorly to analgesics (pain medications)
      • Pain when chewing (chewing pain; Claudicatio masticatoria [pathognomonic symptom / characteristic of the disease]: chewing claudication; due toischemia (reduced blood flow) of the masticatory muscles), tongue pain, swallowing claudication.
      • Hypersensitivity of the scalp (“scalp tenderness”) eg when combing hair.
      • Eye involvement (in 70% of patients).
        • Eye pain
        • Diplopia (double vision, double images), due to muscle, cranial nerve, or brainstem involvement
        • Visual disturbances, e.g., amaurosis fugax (transient blindness; regression of blindness within minutes).
      • Sensitive temporal arteries (temporal artery).
      • Pressurization, nodules in the area of the temporal arteries, possibly even pulselessness of the same.
      • Cerebral ischemia (due to inflammatory involvement of the vertebral, basilar or carotid supply area), in 3-4% of cases.
    • due toInvolvement of large vessels (aorta and aortic branches):
      • Arm claudication – weakness/pain of one arm due to aortic arch syndrome (inflammatory involvement of the aorta); blood pressure side difference; in up to 15% of cases.
    • Wg. Polymyalgia rheumatica (RZA is associated with polymyalgia rheumatica in more than 50% of cases):Myalgia (muscle pain), emphasized proximallyStiffness in the neck, shoulder and pelvic girdle.
    • Polyneuropathy – occurs in about a quarter of those affected.
    • Depression

    The following general symptoms may occur wg systemic inflammation:

    • Fever
    • Night sweats (night sweats)
    • Fatigue
    • Anorexia (loss of appetite)
    • Weight loss
    • Anemia (anemia)